Massachusetts Medicaid ABA Reimbursement Rates (2026)
From official Massachusetts Medicaid sources. Updated July 2026.
These are the published Massachusetts 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.
Massachusetts ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97151 | Behavior identification assessment, physician/QHP, each 15 min (initial FBA and reassessment) Per-15-min rate, NOT per assessment. | $30.73 | per 15 min | 2024-10-01 | source |
| 97153 | Adaptive behavior treatment by protocol, technician, each 15 min Verified exactly in 101 CMR 358.03(3) fee schedule; proposed re-adoption 12/1/2026 keeps rate unchanged. | $16.37 | per 15 min | 2024-10-01 | source |
| 97154 | Group adaptive behavior treatment by protocol, technician, 2+ patients, each 15 min (social skills group, up to 8 participants) Published as a single per-15-min rate for the group code. | $13.91 | per 15 min | 2024-10-01 | source |
| 97155 | Adaptive behavior treatment with protocol modification, physician/QHP, each 15 min Rate/unit/date verified; description corrected — MA does not tier by BCBA, regulation says physician or other qualified health care professional (removed ‘(BCBA)’ tag). | $30.73 | per 15 min | 2024-10-01 | source |
| 97156 | Family adaptive behavior treatment guidance, physician/QHP, each 15 min Verified exactly in 101 CMR 358.03(3). | $30.73 | per 15 min | 2024-10-01 | source |
| 97157 | Multiple-family group adaptive behavior treatment guidance, physician/QHP, each 15 min (group parent training, up to 8 participants) | $26.12 | per 15 min | 2024-10-01 | source |
| H0031 (U2) | Mental health assessment by physician/QHP — assessment and case planning for home services by a licensed professional Only modifier-coded line on the MA ABA fee schedule; explicitly labeled a 15-minute rate. | $30.73 | per 15 min | 2024-10-01 | source |
How Massachusetts Compares
| Code | Massachusetts | National median | Difference |
|---|---|---|---|
| 97151 | $30.73 | $29.14 | 5% above national median |
| 97153 | $16.37 | $15.00 | 9% above national median |
| 97155 | $30.73 | $24.18 | 27% above national median |
| 97156 | $30.73 | $22.50 | 37% above national median |
Market Context
About 692,117 children in Massachusetts are enrolled in Medicaid. Autism prevalence is 4.5% (2022 data). ProviderSpark lists 215 verified ABA provider locations in Massachusetts.
Getting Paneled with MassHealth
ABA is a behavioral-health carve-out under MassHealth: you don’t enroll directly with the state, you credential with whichever Managed Care Entity (MCE) covers the members you want to serve.
- Submit a MassHealth Provider Application with your NPI and licensure documentation, then register for the Provider Online Service Center once approved.
- Identify which MCE covers your target members and complete a CAQH ProView profile so the MCE can access it — see Carelon Behavioral Health / MBHP getting-started.
- Submit a network-participation request directly to that MCE, for example through the Optum provider network portal for Massachusetts.
- Once contracted, confirm your LABA supervisor(s) and BT staff meet the MCE’s ABA performance specifications before you bill.
- Submit the Standard Prior Authorization Form for ABA Services, completed by the supervising LABA, for each member before treatment starts.
How Massachusetts Delivers ABA
Massachusetts pays for ABA through managed care, not fee-for-service. MassHealth contracts behavioral health, including ABA, to three MCEs: Carelon Behavioral Health (formerly Massachusetts Behavioral Health Partnership / MBHP), Tufts Health Public Plans, and Optum Behavioral Health. The rate you’re actually paid depends on your contract with whichever MCE you credential with, even though underlying rates are set statewide in 101 CMR 358.00.
Those statewide rates aren’t generous. MassHealth re-adopted its ABA fee schedule effective December 1, 2026 with every rate held flat at October 2024 levels, including $16.37 per 15-minute unit (roughly $65/hour) for technician-delivered code 97153. A Massachusetts ABA association representative testified at a June 17, 2026 hearing that this freeze falls well below neighboring states, citing roughly $88/hour in Arizona and $83/hour in Maryland.
Billing Notes
Prior authorization is required for all ABA services, hours, and units, for every member, submitted on the statewide Standard PA Form by the rendering or supervising LABA. Authorizations don’t exceed 6 months, the initial assessment must be authorized before treatment starts, and hours beyond that need a follow-up request.
Telehealth is allowed: providers can deliver services via a HIPAA-compliant platform at the family’s request when the service can be effectively delivered that way, with documented clinical rationale. Telehealth can’t fully replace in-person availability, and families can rescind consent at any time without losing services.
One billing quirk: because ABA is billed through each member’s assigned MCE, you must credential separately with each MCE whose members you want to serve. Supervision-ratio documentation is also a recurring audit flashpoint — a 2024 state Inspector General review found MassHealth paid an estimated $16.8 million in claims that didn’t meet the required LABA-to-BT supervision ratio, out of roughly $17.3 million in total ABA overpayments found. MassHealth directed its MCEs to send recoupment letters for CY2024 claims in late February 2026, a move providers have disputed.
Common Questions
What does Massachusetts Medicaid pay for CPT 97153?
Massachusetts Medicaid pays $16.37 per 15 minutes for 97153 (direct treatment by a technician). That is about $65.48 per hour.
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 Massachusetts 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 York · Connecticut · New Hampshire · Rhode Island · Vermont