Kentucky Medicaid ABA Reimbursement Rates (2026)
From official Kentucky Medicaid sources. Updated July 2026.
These are the published Kentucky 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.
Kentucky ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97151 (HO) | Behavior identification assessment (LBA, masters level) Was $21.25 eff 2025-04-01; increased in 2026 schedule. Physician AF/AM=$27.50, APRN/Psych/PA=$23.37. | $21.99 | per 15 min | 2026-04-01 | source |
| 97151 (U4) | Behavior identification assessment (LABA / associate w/ supervision) Column 4 associate tier (U4 required modifier) includes LABA. | $19.25 | per 15 min | 2026-04-01 | source |
| 97152 (UC) | Behavior identification supporting assessment (RBT only) Was $11.77 eff 2025-04-01. RBT-only code, single rate. | $12.18 | per 15 min | 2026-04-01 | source |
| 97153 (UC) | Adaptive behavior treatment by protocol (RBT only) Was $11.77 eff 2025-04-01. KY pays 97153 at RBT tier only; no BCBA/LBA rate for this code. | $12.18 | per 15 min | 2026-04-01 | source |
| 97154 (UC) | Group adaptive behavior treatment by protocol (RBT only) Was $11.77 eff 2025-04-01. RBT-only code, single rate; priced per 15 min, not per participant tier. | $12.18 | per 15 min | 2026-04-01 | source |
| 97155 (HO) | Adaptive behavior treatment w/ protocol modification (LBA, masters level) Was $21.25 eff 2025-04-01. Physician AF/AM=$27.50, APRN/Psych/PA=$23.37. | $21.99 | per 15 min | 2026-04-01 | source |
| 97155 (U4) | Adaptive behavior treatment w/ protocol modification (LABA / associate w/ supervision) Column 4 associate tier (U4) includes LABA. | $19.25 | per 15 min | 2026-04-01 | source |
| 97156 (HO) | Family adaptive behavior treatment guidance (LBA, masters level) Was $16.51 eff 2025-04-01. Physician AF/AM=$21.35, APRN/Psych/PA=$18.13. | $17.09 | per 15 min | 2026-04-01 | source |
| 97156 (U4) | Family adaptive behavior treatment guidance (LABA / associate w/ supervision) Column 4 associate tier (U4) includes LABA. | $14.94 | per 15 min | 2026-04-01 | source |
| 97157 (HO) | Multiple-family group adaptive behavior treatment guidance (LBA, masters level) We had 97158 but lacked 97157; same rate columns as 97158. | $8.65 | per 15 min | 2026-04-01 | source |
| 97158 (HO) | Group adaptive behavior treatment w/ protocol modification (LBA, masters level) Was $8.36 eff 2025-04-01. Physician AF/AM=$10.81. | $8.65 | per 15 min | 2026-04-01 | source |
How Kentucky Compares
| Code | Kentucky | National median | Difference |
|---|---|---|---|
| 97151 (HO) | $21.99 | $29.14 | 25% below national median |
| 97153 (UC) | $12.18 | $15.00 | 19% below national median |
| 97155 (HO) | $21.99 | $24.18 | 9% below national median |
| 97156 (HO) | $17.09 | $22.50 | 24% below national median |
Market Context
About 619,007 children in Kentucky are enrolled in Medicaid. Autism prevalence is 3.7% (2022 data). ProviderSpark lists 135 verified ABA provider locations in Kentucky.
Getting Paneled with Kentucky Medicaid (administered by the Cabinet for Health and Family Services, Department for Medicaid Services)
Kentucky Medicaid enrollment for ABA providers runs through several stops, not one application:
- Get licensed as an LBA or LaBA through the Kentucky Applied Behavior Analysis Licensing Board — required before you can enroll as a Medicaid provider.
- Enroll as a Kentucky Medicaid provider (Provider Type 63 for individuals, 639 for groups) through the CHFS provider enrollment process.
- Credential and contract separately with each relevant Medicaid managed care organization: Aetna Better Health of Kentucky, Humana Healthy Horizons in Kentucky, Passport Health Plan by Molina Healthcare, UnitedHealthcare Community Plan of Kentucky, and WellCare of Kentucky. Anthem exited Kentucky Medicaid managed care on January 1, 2025, so it’s no longer part of this list.
- Verify each beneficiary’s eligibility and whether they’re fee-for-service or MCO-enrolled through KYHealth-Net before you bill.
How Kentucky Delivers ABA
Kentucky runs a hybrid model: some beneficiaries are fee-for-service, others are enrolled with one of the five MCOs above. That matters for your revenue, because enrolling with the state alone doesn’t get you paid — you need a separate contract with each MCO whose members you want to see. A practice that only completes state enrollment can end up unable to bill for a large share of its Medicaid caseload simply because it isn’t credentialed with the plan those clients happen to carry.
Billing Notes
Prior authorization is required for ABA services in Kentucky. For fee-for-service beneficiaries, PA runs through CareWise; for MCO-enrolled beneficiaries, PA goes through that member’s specific plan — for example, UnitedHealthcare Community Plan routes its KY ABA program through Provider Express/Optum. Telehealth is explicitly permitted: 907 KAR 3:170 names licensed behavior analysts among the behavioral health practitioners authorized to deliver services via telehealth, and requires those services be reimbursed at the same rate as comparable in-person visits. The practical billing quirk to plan for is the hybrid structure itself — enrolling with the state and credentialing with each MCO are separate steps, and providers commonly cite that split as a source of enrollment and billing friction.
Common Questions
What does Kentucky Medicaid pay for CPT 97153?
See the rate table above for the codes Kentucky 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 Kentucky 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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