New Jersey Medicaid ABA Reimbursement Rates (2026)
From official New Jersey Medicaid sources. Updated July 2026.
These are the published New Jersey 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.
New Jersey ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97151 | Behavior identification assessment (BCBA/QHP) | $25.00 | per 15 min | — | source |
| 97153 | Adaptive behavior treatment by protocol Horizon NJ Health MCO rate. Raised from $11.20. MCO-negotiated, not FFS. | $15.00 | per 15 min | 2022-02-01 | source |
| 97155 | Adaptive behavior treatment w/ protocol modification (BCBA/QHP) | $21.25 | per 15 min | — | source |
| 97156 | Family adaptive behavior treatment guidance | $25.00 | per 15 min | — | source |
How New Jersey Compares
| Code | New Jersey | National median | Difference |
|---|---|---|---|
| 97151 | $25.00 | $29.14 | 14% below national median |
| 97153 | $15.00 | $15.00 | 0% above national median |
| 97155 | $21.25 | $24.18 | 12% below national median |
| 97156 | $25.00 | $22.50 | 11% above national median |
Market Context
About 805,777 children in New Jersey are enrolled in Medicaid. Autism prevalence is 3.8% (2022 data). ProviderSpark lists 489 verified ABA provider locations in New Jersey.
Getting Paneled with NJ FamilyCare
NJ FamilyCare, New Jersey’s Medicaid/CHIP program, has covered ABA as a benefit for beneficiaries under 21 with an autism diagnosis since April 1, 2020, as part of the broader ASD Developmental Services benefit that launched July 1, 2020. Getting paid requires two separate steps: a state Medicaid ID and a contract with the managed care plan holding the member.
- Get an NJ Medicaid provider number by submitting the ASD Treatment Provider Application plus the ABA Treatment Provider Addendum to Gainwell (formerly DXC) Provider Enrollment, by email at Njmmisproviderenrollment@dxc.com, fax, or mail.
- Or start directly through the NJMMIS Provider Enrollment portal — select the ABA Treatment Provider type (revalidating providers attach the Revalidation Cover Page).
- Separately contract and credential with each NJ FamilyCare MCO you want to bill through. MCO contracting is independent of your state Medicaid ID.
- For questions on the ASD/ABA benefit itself, contact DMAHS’s ABA & DIR Services line at MAHS.ASDinquiries@dhs.nj.gov.
- Once contracted with an MCO (or covered under the temporary fee-for-service bridge before MCO assignment), request prior authorization through that payer’s portal — for example, UHC/Optum uses the Provider Express portal with a One Healthcare ID.
How New Jersey Delivers ABA
New Jersey runs a hybrid model. Most ABA gets billed through managed care organizations: Aetna Better Health of New Jersey, Horizon NJ Health, UnitedHealthcare Community Plan of New Jersey (its ABA network is administered by Optum, not UHC directly), WellCare of New Jersey, and Wellpoint New Jersey (rebranded from Amerigroup Community Care in January 2024). What that means for your rate: the state Medicaid ID gets you in the door, but the actual rate you’re paid depends on the individual contract you negotiate with each MCO. Holding a state ID doesn’t guarantee you’re in-network, or paid the same, across all five plans.
Billing Notes
Prior authorization is required for assessment (97151) and treatment (97153/97154/97155/97156) codes once a member is assigned to an MCO, before services are delivered. Before that MCO assignment happens, there can be a temporary Medicaid fee-for-service bridge period where the state covers medically necessary ABA directly, and no prior authorization is required for the initial diagnostic evaluation or ABA assessment.
Telehealth ABA is covered. It’s billed with the normal code (such as 97155 or 97156) plus place-of-service code “02” to flag virtual delivery. One thing to watch on the calendar: New Jersey’s telehealth payment-parity requirement for State Medicaid/NJ FamilyCare has been extended by the legislature multiple times and currently runs through July 1, 2026. It’s a time-limited extension, not permanent law, so confirm it’s still in force before building telehealth into your rate assumptions past that date.
Common Questions
What does New Jersey Medicaid pay for CPT 97153?
New Jersey Medicaid pays $15.00 per 15 minutes for 97153 (direct treatment by a technician). That is about $60.00 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 New Jersey 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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