Missouri Medicaid ABA Reimbursement Rates (2026)
From official Missouri Medicaid sources. Updated July 2026.
These are the published Missouri 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.
Missouri ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97151 (HO) | Behavior identification assessment – Behavior Analyst or Psychologist (HO tier; only tier payable) Stored rate $23.50 with no modifier was wrong. Official rate $25.26/15 min, max 32 units, PA required. U8+HO variant pays $27.46 on the legacy 0362T assessment code but 97151 U8 is also $25.26. | $25.26 | per 15 min | 2022-07-01 | source |
| 97153 (HO) | Adaptive behavior treatment by protocol – Behavior Analyst or Psychologist HN (Assistant Behavior Analyst) tier pays the same $20.13. Effective 7/1/2024 rate increase. Max 32 units. | $20.13 | per 15 min | 2024-07-01 | source |
| 97153 (HO HM) | Adaptive behavior treatment by protocol – Registered Behavior Technician (HM second modifier) Stored $12.50 unmodified was wrong. RBT tier is $16.37/15 min effective 7/1/2024 (also billed HN+HM). Max 32 units/day, PA required except TM rows. | $16.37 | per 15 min | 2024-07-01 | source |
| 97155 (HN) | Adaptive behavior treatment with protocol modification – Assistant Behavior Analyst Max 24 units, PA required. | $17.73 | per 15 min | 2022-07-01 | source |
| 97155 (HO) | Adaptive behavior treatment with protocol modification – Behavior Analyst or Psychologist Stored $20.00 unmodified was wrong. $25.26/15 min; U8+HO variant pays $27.46. Max 24 units, PA required. | $25.26 | per 15 min | 2022-07-01 | source |
| 97156 (HN) | Family adaptive behavior treatment guidance – Assistant Behavior Analyst Increased effective 7/1/2024. Max 16 units, PA required. | $20.13 | per 15 min | 2024-07-01 | source |
| 97156 (HO) | Family adaptive behavior treatment guidance – Behavior Analyst or Psychologist Max 16 units, PA required. | $25.26 | per 15 min | 2022-07-01 | source |
How Missouri Compares
| Code | Missouri | National median | Difference |
|---|---|---|---|
| 97151 (HO) | $25.26 | $29.14 | 13% below national median |
| 97153 (HO) | $20.13 | $15.00 | 34% above national median |
| 97155 (HO) | $25.26 | $24.18 | 4% above national median |
| 97156 (HO) | $25.26 | $22.50 | 12% above national median |
Market Context
Missouri has had an autism insurance mandate since 2010. About 580,453 children in Missouri are enrolled in Medicaid. Autism prevalence is 3.5% (2022 data). ProviderSpark lists 90 verified ABA provider locations in Missouri.
Getting Paneled with MO HealthNet (Missouri Medicaid), administered by the MO HealthNet Division (MHD), Department of Social Services
Missouri pays for ABA outside its managed care system entirely. Even though most MO HealthNet members are enrolled in a managed care plan, ABA is carved out statewide and paid fee-for-service directly by the state — the managed care plans aren’t required to cover it. That means your reimbursement doesn’t depend on which plan a client happens to be enrolled in.
- Confirm your eligibility to enroll as an ABA provider under 13 CSR 70-98.030 (LBAs and LaBAs supervising RBTs).
- Complete the provider enrollment application through the eMOMED provider enrollment portal — make sure your legal name, address, and taxonomy match your NPI registry exactly.
- Track your application or resolve documentation issues with the Missouri Medicaid Audit & Compliance (MMAC) Provider Enrollment Unit; applications are processed in the order they’re received.
- Once enrolled, review the Behavioral Health Services Provider Manual for ABA-specific billing, documentation, and precertification instructions.
How Missouri Delivers ABA
Missouri’s Medicaid program, MO HealthNet, uses managed care organizations for most services — Home State Health, Healthy Blue, United Healthcare, and Show Me Healthy Kids — but ABA sits outside that system. It’s paid fee-for-service by the state regardless of which of those plans a child is enrolled in. Every ABA case, no matter the plan, goes through precertification with the same entity: the Wipro Behavioral Health Help Desk. Practically, that means your rate is set by the state fee schedule rather than negotiated per-plan, and your front-office team only has to build one precertification workflow instead of four.
Billing Notes
All ABA services require precertification — for the initial assessment, the resulting treatment plan, and continued intervention. To qualify, the client must be under 21 with a diagnosis of Autism Spectrum Disorder from a licensed physician or psychologist recommending ABA as medically necessary. Services delivered without precertification are non-allowable, and claims will be denied.
Telehealth is allowed for ABA delivered by an RBT under the supervision of a licensed behavior analyst or psychologist, reimbursed at the same fee schedule rate as an in-person visit. All telehealth ABA follows the same precertification rules as in-person services.
On the billing itself: RBT-delivered services must stack the HM modifier with the supervisor’s modifier (HO for an LBA or psychologist, HN for an LaBA). Don’t add the U8 home/other-location modifier to RBT-billed lines even when the service happens in the client’s home — MHD specifically flags that combination as a billing error. Payment for RBT-delivered services goes to the supervising LBA or psychologist, not the technician or the family, and psychologists should avoid the AH modifier when submitting ABA codes.
Common Questions
What does Missouri Medicaid pay for CPT 97153?
See the rate table above for the codes Missouri 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 Missouri 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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