Iowa Medicaid ABA Reimbursement Rates (2026)
From official Iowa Medicaid sources. Updated July 2026.
These are the published Iowa Medicaid rates for applied behavior analysis (ABA) services. Rates are shown as published. For per-15-minute rows, multiply by 4 for the hourly rate; rows priced per hour, per session, or per assessment are labeled in the table.
Iowa ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97151 (HO) | Behavior identification assessment (master’s-level QHP) Stored with blank modifier; Iowa only publishes 97151 with HO/HP modifiers. Rate confirmed at $35.73. | $35.73 | per 15 min | 2024-07-01 | source |
| 97151 (HP) | Behavior identification assessment (doctoral-level) Same rate as HO tier. | $35.73 | per 15 min | 2024-07-01 | source |
| 97152 (HN) | Behavior identification supporting assessment (technician) Verified; HO/HP tiers also exist at $35.73. | $17.16 | per 15 min | 2024-07-01 | source |
| 97153 (HN) | Adaptive behavior treatment by protocol (bachelor’s-level technician) Verified in current portal CSV; end date open (99999999). | $17.16 | per 15 min | 2024-07-01 | source |
| 97153 (HO) | Adaptive behavior treatment by protocol (master’s-level) Verified in current portal CSV. | $28.59 | per 15 min | 2024-07-01 | source |
| 97153 (HP) | Adaptive behavior treatment by protocol (doctoral-level) Same rate as HO tier. | $28.59 | per 15 min | 2024-07-01 | source |
| 97155 (HO) | Adaptive behavior treatment w/ protocol modification (master’s-level QHP) Stored with blank modifier; Iowa publishes 97155 only with HO/HP. Rate confirmed at $36.81. | $36.81 | per 15 min | 2024-07-01 | source |
| 97155 (HP) | Adaptive behavior treatment w/ protocol modification (doctoral-level) Same rate as HO tier. | $36.81 | per 15 min | 2024-07-01 | source |
| 97156 (HN) | Family adaptive behavior treatment guidance (bachelor’s-level technician) Verified in current portal CSV. | $17.16 | per 15 min | 2024-07-01 | source |
| 97156 (HO) | Family adaptive behavior treatment guidance (master’s-level) Replaces stored bogus unmodified $20.00 row (eff 2025-01-01), which does not exist in the schedule. | $28.59 | per 15 min | 2024-07-01 | source |
| 97156 (HP) | Family adaptive behavior treatment guidance (doctoral-level) Same rate as HO tier. | $28.59 | per 15 min | 2024-07-01 | source |
| 97157 (HO) | Multi-family group adaptive behavior guidance (master’s-level) Verified; HP tier is $8.90. | $8.39 | per 15 min | 2024-07-01 | source |
| 97158 (HO) | Group adaptive behavior treatment w/ protocol modification (master’s-level) Verified; HP tier is $8.90. | $8.39 | per 15 min | 2024-07-01 | source |
How Iowa Compares
| Code | Iowa | National median | Difference |
|---|---|---|---|
| 97151 (HO) | $35.73 | $29.14 | 23% above national median |
| 97153 (HN) | $17.16 | $15.00 | 14% above national median |
| 97155 (HO) | $36.81 | $24.18 | 52% above national median |
| 97156 (HO) | $28.59 | $22.50 | 27% above national median |
Market Context
Iowa has had an autism insurance mandate since 2010. About 331,835 children in Iowa are enrolled in Medicaid. Autism prevalence is 3.0% (2022 data). ProviderSpark lists 44 verified ABA provider locations in Iowa.
Getting Paneled with Iowa Medicaid, delivered mainly through the “Iowa Health Link” managed care program
Iowa moved nearly all Medicaid delivery, including ABA, into managed care under the Iowa Health Link program. Before you can see managed-care members, you first have to enroll as an Iowa Medicaid provider, then contract separately with each managed care organization you want in-network with.
- Get an LBA or LABA license from DIAL and the Board of Behavioral Health Professionals, using proof of your current BACB certification.
- Enroll as an Iowa Medicaid Enterprise (IME) provider through Iowa Medicaid Portal Access (IMPA), submitting the Universal Enrollment Application (Form 470-0254) plus supporting forms.
- Keep your practice address and any satellite offices current with the IME Provider Services Unit as a condition of staying enrolled.
- Credential and contract separately with each Iowa Health Link MCO you want to bill as in-network for; IME enrollment is a prerequisite, not a substitute.
- Bill ABA under CPT 97151-97158 using the modifier that matches who delivered the service, per Iowa Medicaid’s ABA coding letter.
How Iowa Delivers ABA
Iowa runs a hybrid model. IME enrollment is your entry point, but most members are covered through one of three managed care organizations: Iowa Total Care, Molina Healthcare of Iowa, and Wellpoint Iowa (the former Amerigroup Iowa, rebranded January 2024 as part of Elevance Health’s national rebrand). Each MCO negotiates and updates its own rates, so what you actually get paid can depend on which plan the client is on, not just which CPT code you bill. If you want full market coverage, budget time to credential with all three.
Billing Notes
Iowa Medicaid pays ABA differently depending on who delivered the service. Per Informational Letter 2431-MC-FFS, use modifier HP for a doctoral-level BCBA, HO for a master’s-level BCBA, and HN for an assistant behavior analyst, RBT, or non-certified support staff. For CPT 97153, that’s $27.23 under HO/HP versus $16.34 under HN. Technicians and assistants can’t submit their own claims; the supervising LBA or LABA has to bill on their behalf.
Telehealth is a real option for billable hours. Iowa Medicaid’s Approved Telehealth Services list confirms CPT 97151-97158 are reimbursable via live audio/video (modifier 95), effective January 1, 2024. Audio-only billing is not allowed for any of these codes.
One change worth planning around: for dates of service on or after December 1, 2025, Iowa Medicaid applies a site-of-service payment reduction to telehealth claims billed with place of service 02 or 10. Factor that into your telehealth revenue projections going forward.
Common Questions
What does Iowa Medicaid pay for CPT 97153?
See the rate table above for the codes Iowa publishes.
What are the main ABA CPT codes?
97151 is the assessment. 97153 is direct treatment by a technician. 97155 is treatment with protocol modification by the BCBA. 97156 is family guidance.
Are these Iowa rates current?
Rates come from the state fee schedule and were last checked July 2026. Each row links to its source. Always confirm against the current fee schedule before billing.
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