Michigan Medicaid ABA Reimbursement Rates (2026)
From official Michigan Medicaid sources. Updated July 2026.
Michigan ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97153 | Adaptive behavior treatment by protocol (behavior technician) – statewide minimum directed payment Bulletin MMP 24-51 (issued 11/13/2024, per FY2025 budget PA 121 of 2024): PIHPs must pay BHT-ABA services (CPT 97153) not less than $16.50/unit ($66.00/hour), funded via capitation increase under 42 CFR 438.6(c). This is a floor paid through managed care, not an FFS rate; actual contracted rates vary by PIHP/CMHSP region. No superseding 2025/2026 bulletin found as of 2026-07-10. | $16.50 | per 15 min | 2024-11-01 | source |
How Michigan Compares
| Code | Michigan | National median | Difference |
|---|---|---|---|
| 97153 | $16.50 | $15.00 | 10% above national median |
Market Context
Michigan has had an autism insurance mandate since 2012. About 894,501 children in Michigan are enrolled in Medicaid. Autism prevalence is 3.8% (2022 data). ProviderSpark lists 259 verified ABA provider locations in Michigan.
Getting Paneled with Michigan Medicaid (administered by MDHHS); ABA is delivered as part of the Medicaid Behavioral Health Treatment (BHT) / autism benefit under the Behavioral and Physical Health and Aging Services Administration
ABA in Michigan runs through a specialty behavioral-health carve-out, not standard Medicaid managed care, so the enrollment path has an extra layer most providers don’t expect:
- Enroll as a Michigan Medicaid provider through CHAMPS: get an NPI, register for a MiLogin account, and submit the online CHAMPS provider enrollment application. Register for MiLogin
- Meet MDHHS’s BHT/ABA staff qualification standards: BACB-certified, LARA-licensed BCBA/LBA as the credentialed clinician; behavior technicians and RBTs do not need a license or certification to provide the behavioral-intervention component. MDHHS Numbered Letter L 24-78
- Because ABA is a specialty behavioral-health carve-out, contract and credential directly with the regional PIHP/CMHSP that serves your client’s county, not a standard Medicaid Health Plan. Specialty behavioral health services
- Submit a prior authorization request for ABA hours to that PIHP’s utilization management unit before starting services. Prior authorization
How Michigan Delivers ABA
Michigan uses a hybrid model. General medical Medicaid runs through 9 statewide Medicaid Health Plans (Aetna Better Health, Blue Cross Complete, HAP CareSource, McLaren Health Plan, Meridian Health Plan, Molina Healthcare, Priority Health Choice, UnitedHealthcare Community Plan, and Upper Peninsula Health Plan), but ABA/BHT is carved out separately and administered by 10 regional Prepaid Inpatient Health Plans (PIHPs) working through local Community Mental Health Services Programs (CMHSPs), such as Mid-State Health Network in Region 5. In practice, this means the health plan a client is enrolled in doesn’t determine who pays for ABA. Your contract with the beneficiary’s regional PIHP/CMHSP does, and that’s the relationship that sets your actual authorization and payment process.
Billing Notes
Prior authorization is generally required before starting ABA services delivered through the PIHP/CMHSP carve-out, following the same rule as the in-person equivalent service. Telehealth-delivered ABA is generally reimbursed at parity with in-person care under MDHHS Bulletin MMP 23-10 (effective May 12, 2023): same rate, same place-of-service code, plus modifier 93 for audio-only or 95 for audio-video, with no separate PA requirement beyond what the in-person service would need.
On rates, MDHHS set a hard reimbursement floor that PIHPs must pay providers for direct BHT-ABA treatment (CPT 97153): at least $16.50 per 15-minute unit, or $66.00 per hour, effective November 1, 2024 under Bulletin MMP 24-51. The billing quirk to watch for: because ABA runs through the PIHP/CMHSP carve-out rather than standard CHAMPS fee-for-service or the 9 Medicaid Health Plans, providers who complete only the standard CHAMPS enrollment often find they still can’t get authorized or paid until they separately contract with the correct regional PIHP/CMHSP.
Common Questions
What does Michigan Medicaid pay for CPT 97153?
Michigan Medicaid pays $16.50 per 15 minutes for 97153 (direct treatment by a technician). That is about $66.00 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 Michigan 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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