Maine Medicaid ABA Reimbursement Rates (2026)
From official Maine Medicaid sources. Updated July 2026.
These are the published Maine 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.
Maine ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| H2021 (TJ HI) | Adaptive Skills Training, one-to-one (BHP) – Section 28 base tier Base (non-ABA-specialized) adaptive behavior service tier under the same Section 28 schedule. Group tiers: UN $11.19, UP $7.97, UQ $6.44. | $20.51 | per 15 min | 2026-04-30 | source |
| H2021 (U1 HK) | Applied Behavior Analysis, one-to-one (BHP, community) – Section 28 specialized tier Maine’s ABA 1:1 treatment rate. Same rate in effect since 1/1/2026 under the prior RCS schedule name (Specialized Home and Community, One-to-One). BHP delivers under supervising BCBA; BCBA cost bundled in rate. | $27.87 | per 15 min | 2026-04-30 | source |
| H2021 (U1 HK UN) | Applied Behavior Analysis, 2-member group (BHP, community) Per participant, per 15 min. | $15.19 | per 15 min | 2026-04-30 | source |
| H2021 (U1 HK UP) | Applied Behavior Analysis, 3-member group (BHP, community) Per participant, per 15 min. | $10.82 | per 15 min | 2026-04-30 | source |
| H2021 (U1 HK UQ) | Applied Behavior Analysis, 4-8 member group (BHP, community) Per participant, per 15 min. | $8.76 | per 15 min | 2026-04-30 | source |
| H2021 (U2 HK) | Applied Behavior Analysis, school-related, one-to-one (BHP) School-related ABA tier; TL/TM modifiers may be required for IDEA-related services. | $23.43 | per 15 min | 2026-04-30 | source |
Market Context
Maine has had an autism insurance mandate since 2011. About 139,804 children in Maine are enrolled in Medicaid. Autism prevalence is 5.1% (2022 data). ProviderSpark lists 15 verified ABA provider locations in Maine.
Getting Paneled with MaineCare
MaineCare’s ABA-type benefit, Section 28, no longer accepts solo BCBA enrollment. If you’re a BCBA, you’ll enroll as staff of, or under contract with, an already-enrolled Section 28 provider agency rather than as an independent biller. Agencies handle the steps below.
- Review the Overview of the Steps to Enroll with MaineCare and check your ACA-mandated Risk Category Assignment (limited, moderate, or high risk) before starting.
- Register for a Trading Partner Account (TPA) — required before accessing the enrollment application. Note: MaineCare is migrating this to a new “MaineCare Partner Portal,” targeted for early October 2026.
- Sign in and complete the Provider Enrollment Application (PEA) in MIHMS, entering provider type, specialty, rendering providers, and service locations.
- For Section 28 ABA/behavioral services, the agency enrolls as the Section 28 provider and ensures it has BHP-certified direct-care staff and a supervising BCBA or licensed psychologist on staff.
- Questions go to Provider Enrollment support: MainecareEnroll@gainwelltechnologies.com or 1-866-690-5585, option 2.
How Maine Delivers ABA
MaineCare pays Section 28 services fee-for-service — there are no managed care organizations administering ABA benefits in Maine, so the rate MaineCare sets is the rate you get. The Section 28 rule itself changed recently, too: the old “Rehabilitative and Community Support Services for Children” rule was repealed and replaced by “Adaptive Behavior Services for Children,” effective April 29, 2026, as part of Maine’s DOJ settlement-agreement compliance. If you’re still using the old Section 28 RCS name, switch to the current one.
Billing Notes
Section 28 services (Standard RCS and Specialized Services, which cover ABA-type interventions) require prior authorization through MaineCare’s authorized service agent, Acentra Health (formerly KEPRO), with periodic review for continued medical necessity. An emergency rule effective January 30, 2026 tightened eligibility further: except for school-delivered/IEP services, a child now needs a Level 3 or higher score on the age-appropriate Level of Care/Service Intensity Tool, via the Chapter I Section 7 Single Assessment process — worth confirming if you haven’t checked since that date.
Telehealth is limited for direct service delivery. Specialized Services and Standard RCS must be delivered by BHPs in person; telehealth is only allowed for unforeseen, uncontrollable circumstances (inclement weather, unplanned travel, a family illness), never as a planned or routine part of treatment. Supervising BCBAs, however, can deliver supervision and BCBA-level direct services by telehealth, as long as MaineCare’s telehealth quality standards (MBM Chapter I, Section 4) are met.
On rates: MaineCare fully bundles supervising-BCBA cost into the Specialized Services rate (HCPCS H2021, with U1/U2 and HK modifiers). As of March 2025 billing guidance, BCBA time is not separately billable under any code — the former standalone code (G9007 HA) was removed with no exception. Build your rate expectations around the bundled H2021 rate rather than planning to bill BCBA time on its own.
Common Questions
What does Maine Medicaid pay for CPT 97153?
See the rate table above for the codes Maine 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 Maine 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.
Compare neighboring states: New Hampshire · Massachusetts · Vermont