Minnesota Medicaid ABA Reimbursement Rates (2026)
From official Minnesota Medicaid sources. Updated July 2026.
These are the published Minnesota 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.
Minnesota ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 0373T (UB) | Higher-intensity adaptive behavior treatment, two or more providers — all provider levels (100%) Verified in current MHCP fee schedule (eff. 2024-11-01). Pays 100% at every level incl. Level III. Billed once per period based on one provider’s face-to-face time; limit 8 hrs/day. MN uses 0373T instead of 97158. | $24.19 | per 15 min | 2024-11-01 | source |
| 97151 (UB) | Behavior identification assessment (CMDE) — CMDE provider, 100% of base Rate verified in current MHCP fee schedule (file last modified 2026-07-07). Stored row lacked the UB modifier all EIDBI claims require. Max 80 units (20 hrs) per calendar year without service agreement; one CMDE/yr. | $50.11 | per 15 min | 2024-01-01 | source |
| 97153 (UB) | Adaptive behavior treatment by protocol — QSP or Level I provider (100% of base) Base rate verified in current MHCP fee schedule. EIDBI billing grid (Jan 2026): QSP/Level I paid 100%. Limit 8 hrs/day. Stored row lacked UB modifier and tier label. | $20.17 | per 15 min | 2024-01-01 | source |
| 97154 (UB) | Group adaptive behavior treatment by protocol — QSP or Level I provider (100% of base), priced per participant Verified in current MHCP fee schedule. Tiers: Level II 80%, Level III 50%. Up to 8 people per group; limit 4.5 hrs/day. | $6.72 | per 15 min | 2024-01-01 | source |
| 97155 (UB) | Adaptive behavior treatment w/ protocol modification (observation & direction) — QSP or Level I provider (100% of base) Base rate verified in current MHCP fee schedule. Level II paid 80% (est. $16.14); no Level III for this code. Limit 6 hrs/day; authorized 97155 should be ~20% of total intervention time. Stored row lacked UB modifier. | $20.17 | per 15 min | 2024-01-01 | source |
| 97156 (UB) | Family adaptive behavior treatment guidance — QSP or Level I provider (100% of base) Base rate verified in current MHCP fee schedule. Level II paid 80% (est. $16.14); no Level III. Limit 4 hrs/day. Stored row lacked UB modifier. | $20.17 | per 15 min | 2024-01-01 | source |
| 97157 (UB) | Multiple-family group adaptive behavior treatment guidance — QSP or Level I provider (100% of base) Verified in current MHCP fee schedule. Level II 80%; no Level III. Up to 8 families/couples per group; limit 4 hrs/day. | $6.72 | per 15 min | 2024-01-01 | source |
| H0032 (UB) | Individual Treatment Plan development and monitoring — QSP or Level I provider (100% of base), per encounter Verified in current MHCP fee schedule. Level II paid 80% (est. $65.95). Billed per encounter as clinically necessary. | $82.44 | per session | 2024-01-01 | source |
| T1024 (UB) | Coordinated care conference (medical team conference) — all eligible levels 100%, per encounter Verified in current MHCP fee schedule. Billed per encounter as clinically necessary; multiple providers may bill simultaneously. | $112.67 | per session | 2024-01-01 | source |
How Minnesota Compares
| Code | Minnesota | National median | Difference |
|---|---|---|---|
| 97151 (UB) | $50.11 | $29.14 | 72% above national median |
| 97153 (UB) | $20.17 | $15.00 | 34% above national median |
| 97155 (UB) | $20.17 | $24.18 | 17% below national median |
| 97156 (UB) | $20.17 | $22.50 | 10% below national median |
Market Context
Minnesota has had an autism insurance mandate since 2013. About 611,112 children in Minnesota are enrolled in Medicaid. Autism prevalence is 3.9% (2022 data). ProviderSpark lists 49 verified ABA provider locations in Minnesota.
Getting Paneled with Minnesota Health Care Programs (MHCP)
Minnesota delivers ABA for people under 21 with autism spectrum disorder or a related condition through the EIDBI (Early Intensive Developmental and Behavioral Intervention) benefit under Medical Assistance and MinnesotaCare. Enrollment happens in two layers: your agency has to be an actively enrolled EIDBI provider before any individual Level I/II/III treatment providers or QSPs on staff can enroll and bill. That two-layer structure trips up a lot of new providers.
- Get your agency actively enrolled as an EIDBI provider first — individual staff can’t enroll until the agency is approved. See DHS EIDBI provider enrollment.
- Complete a NETStudy 2.0 background study for owners with a 5%+ stake, operators, board members, and any staff or volunteer providing direct-contact EIDBI services.
- Submit the level-specific EIDBI provider assurance statement, for example DHS-7120D for Level I, documenting your license, certifications, and transcripts as applicable.
- Submit the full enrollment packet through the Minnesota Provider Screening and Enrollment (MPSE) portal, or fax it to MHCP Provider Eligibility and Compliance at 651-431-7462. Start at mn.gov/dhs.
- Expect MHCP to review your request in the order received, respond in about 30 days, and then run a required site visit plus up to 60 more days of screening.
How Minnesota Delivers ABA
Minnesota runs a hybrid model. About two-thirds of MA and MinnesotaCare enrollees sit in a managed-care plan (PMAP, MSHO, or MSC+), and the rest are fee-for-service. The managed-care organizations include Blue Plus, HealthPartners, Medica, PrimeWest Health, South Country Health Alliance, UCare, Metropolitan Health Plan, and Itasca Medical Care.
No matter which MCO a client is enrolled in, EIDBI-specific prior authorization is centralized through Acentra Health as the statewide review agent. Your reimbursement rate may vary by plan, but the authorization process itself doesn’t change based on the MCO.
Billing Notes
Acentra Health handles prior authorization for individual and group EIDBI intervention, CMDE, and observation/direction, submitted through the Atrezzo portal. They act (approve, deny, or pend) within 5 business days, and each authorization request can’t span more than 180 days. CMDE and Individual Treatment Plan development don’t need prior authorization (once a year) unless you exceed billing-grid thresholds, but observation and direction always require it. For clients enrolled in Special Needs BasicCare (SNBC), fee-for-service EIDBI rules apply instead of the MCO’s own process.
Telehealth is covered at full parity — Minnesota law requires Medical Assistance to cover medically necessary EIDBI services delivered via telehealth the same as in-person, at the full allowable rate. Two carve-outs to know: Level III technicians can’t deliver EIDBI services via telehealth at all, and a QSP’s required monthly observation/direction sessions can only be done via telehealth for up to two consecutive months at a time.
Common Questions
What does Minnesota Medicaid pay for CPT 97153?
See the rate table above for the codes Minnesota 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 Minnesota 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: Wisconsin · Iowa · North Dakota · South Dakota