Nevada Medicaid ABA Reimbursement Rates (2026)
From official Nevada Medicaid sources. Updated July 2026.
These are the published Nevada 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.
Nevada ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97151 | Behavior identification assessment (specialty 310 LBA/BCBA) Verified in PT85 fee schedule XLSX (rate data as of 07/2026), specialty 310, rate type BH3, Rate Begin Date 03/10/2025. Rate level unchanged since 7/1/2023 SB 504 increase (Web Announcement 3263). Specialty 311 pays $17.54 for same code. | $29.14 | per 15 min | 2025-03-10 | source |
| 97153 | Adaptive behavior treatment by protocol (specialty 310/311 professional-billed) Verified: specialties 310 and 311 both $30.10, Rate Begin Date 03/10/2025. Note this is the professional-billed rate; BCaBA/RBT bill with UD at lower rates (added as separate rows). | $30.10 | per 15 min | 2025-03-10 | source |
| 97153 (UD) | Adaptive behavior treatment by protocol (specialty 312 BCaBA, modifier UD) PT85 schedule: specialty 312, rate type BH1, Rate Begin Date 01/01/2022. BCaBA claims must include modifier UD per PT85 Billing Guide. | $18.06 | per 15 min | 2022-01-01 | source |
| 97154 | Group adaptive behavior treatment by technician (specialty 310, per participant) Specialty 310 $7.60; UD tiers: 312 $7.50, 314 $7.08 (eff 7/1/2023). Priced per 15 min per patient. | $7.60 | per 15 min | 2025-03-10 | source |
| 97155 | Adaptive behavior treatment w/ protocol modification (specialty 310/311 LBA/BCBA) Verified: specialties 310 and 311 both $30.10, Rate Begin Date 03/10/2025. | $30.10 | per 15 min | 2025-03-10 | source |
| 97155 (UD) | Adaptive behavior treatment w/ protocol modification (specialty 312 BCaBA, modifier UD) PT85 schedule: specialty 312, Rate Begin Date 07/01/2023 (SB 504 increase per Web Announcement 3263). | $19.92 | per 15 min | 2023-07-01 | source |
| 97156 | Family adaptive behavior treatment guidance (specialty 310 LBA/BCBA) Verified: specialty 310 $21.32 (Rate Begin Date 03/10/2025); specialty 311 $21.17. Rate level dates to 7/1/2023 increase. No UD tier published for 97156. | $21.32 | per 15 min | 2025-03-10 | source |
| 97158 | Group adaptive behavior treatment w/ protocol modification (specialty 310/311) Specialties 310 and 311 both $14.28, Rate Begin Date 03/10/2025. 97157 (multi-family group) is $11.70. | $14.28 | per 15 min | 2025-03-10 | source |
How Nevada Compares
| Code | Nevada | National median | Difference |
|---|---|---|---|
| 97151 | $29.14 | $29.14 | 0% above national median |
| 97153 | $30.10 | $15.00 | 101% above national median |
| 97155 | $30.10 | $24.18 | 24% above national median |
| 97156 | $21.32 | $22.50 | 5% below national median |
Market Context
About 320,581 children in Nevada are enrolled in Medicaid. Autism prevalence is 3.6% (2022 data). ProviderSpark lists 184 verified ABA provider locations in Nevada.
Getting Paneled with Nevada Medicaid and Nevada Check Up (state Medicaid/CHIP program, administered by the Division of Health Care Financing and Policy, DHCFP); ABA billed under Provider Type 85
- Confirm you hold the correct license/registration: LBA (specialty 310), Psychologist (311), LaBA/BCaBA (312), or RBT (314); agencies enroll as specialty 885. See the Provider Type 85 enrollment checklist and complete it for your specialty.
- Submit your application electronically through Provider Flex — paper applications aren’t accepted. Sign via DocuSign and upload your license image plus a liveness video (associated providers are excluded).
- Once enrolled with an active NPI, use the Provider Web Portal to submit claims, check eligibility, and request prior authorization.
- Questions during enrollment go to the Gainwell Technologies Provider Enrollment Unit at 1-877-638-3472.
How Nevada Delivers ABA
Nevada runs a hybrid model: some claims are fee-for-service, and some route through one of four MCOs — Anthem Blue Cross and Blue Shield Healthcare Solutions, Health Plan of Nevada (HPN), Molina Healthcare of Nevada, and SilverSummit Healthplan. Which MCO a client is assigned to affects which network you join and how fast you get paid, so check each one separately from your state enrollment.
Nevada Medicaid caps combined treatment codes (97153/97155/0373T) at 15-25 hours/week under the Focused model or 25-40 hours/week under the Comprehensive model, and technician supervision by the BCBA/LBA can’t exceed 20% of total treatment hours. Both can be exceeded with prior authorization and documented medical necessity — see the Provider Type 85 billing guidelines.
Billing Notes
Assessment codes 97151, 97152, and 0362T do not require prior authorization. Treatment codes 97153-97158 and 0373T do — request through the Provider Web Portal or Forms FA-11E and FA-11F, up to 15 business days before or no more than 15 calendar days after the service start date, with a documented diagnosis of ASD, FASD, or another medically necessary condition.
Telehealth reimbursement is restricted. Per Nevada Medicaid Web Announcement 3449, effective for dates of service on or after September 23, 2024, telehealth (Place of Service code 10) claims for codes 97153, 97154, 97158, 0362T, and 0373T deny automatically with no reprocessing. Codes 97151, 97152, 97155, 97156, and 97157 weren’t named there — confirm current rules in the Provider Web Portal before billing telehealth for those.
Every service must be billed under the NPI of the person who delivered it, never the supervising clinician’s, and date-span billing isn’t allowed. BCaBA and RBT claims need modifier UD. Combined units across 0373T and 97153-97158 are capped at 40 hours/week per recipient. A 2021 state audit found close to 1,000 provider-days with an “unreasonable and possibly fraudulent” number of billed hours since 2016 — some at or above 24 hours in a day.
Common Questions
What does Nevada Medicaid pay for CPT 97153?
Nevada Medicaid pays $30.10 per 15 minutes for 97153 (direct treatment by a technician). That is about $120.40 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 Nevada 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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