New York Medicaid ABA Reimbursement Rates (2026)
From official New York Medicaid sources. Updated July 2026.
These are the published New York 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 York ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97151 | Behavior identification assessment | $19.26 | per 15 min | 2025-10-01 | source |
| 97153 | Adaptive behavior treatment by protocol Being reduced to $14.45 eff 4/1/2026. | $14.45 | per 15 min | 2026-04-01 | source |
| 97155 | Adaptive behavior treatment w/ protocol modification | $19.26 | per 15 min | 2025-10-01 | source |
| 97156 | Family adaptive behavior treatment guidance | $19.26 | per 15 min | 2025-10-01 | source |
How New York Compares
| Code | New York | National median | Difference |
|---|---|---|---|
| 97151 | $19.26 | $29.14 | 34% below national median |
| 97153 | $14.45 | $15.00 | 4% below national median |
| 97155 | $19.26 | $24.18 | 20% below national median |
| 97156 | $19.26 | $22.50 | 14% below national median |
Market Context
About 2,462,008 children in New York are enrolled in Medicaid. Autism prevalence is 3.8% (2022 data). ProviderSpark lists 363 verified ABA provider locations in New York.
Getting Paneled with New York Medicaid (fee-for-service claims processed through eMedNY; managed-care side is NYS Medicaid Managed Care / MMC — no special program nickname like other states)
New York doesn’t run a single unified ABA benefit. Claims flow through eMedNY on the fee-for-service side and through MMC plans on the managed-care side, with ABA carved into the MMC benefit package as of January 1, 2023. Getting paid means threading both.
- Get licensed as an LBA (or certified as a CBAA) through NYSED’s Office of the Professions.
- Enroll as a NYS Medicaid FFS provider through eMedNY. LBAs enroll to bill directly; CBAAs enroll as an OPRA provider since they can’t bill on their own, and the supervising LBA bills for them.
- Delivering ABA in an Article 28 facility? Enroll as an OPRA provider and affiliate with the facility so it can bill on the Ordered Ambulatory Fee Schedule.
- For Medicaid Managed Care members, credential and contract separately with each MMC plan you want to bill.
- Revalidate your NYS Medicaid FFS enrollment every 5 years.
How New York Delivers ABA
New York runs a hybrid model: fee-for-service through eMedNY plus managed care through a long list of MMC plans, including MetroPlus Health Plan, Healthfirst PHSP, Fidelis Care New York, HIP of Greater NY/EmblemHealth, UnitedHealthcare Community Plan, Empire BlueCross BlueShield HealthPlus, Excellus, MVP Health Care, Independent Health Association, CDPHP, Highmark Western & Northeastern NY, and Molina Healthcare of New York. Your actual reimbursement depends on which plan a client carries, not one statewide FFS rate. ABA only entered the MMC benefit package in January 2023, so contracting with these plans is still a relatively new process — don’t assume a fast credentialing timeline with any one plan.
Billing Notes
The FFS ABA Policy Manual doesn’t spell out a universal prior-authorization requirement. Coverage instead runs off a referral from a NYS-licensed, Medicaid-enrolled physician, psychologist, psychiatric/pediatric nurse practitioner, or PA, good for up to two years, plus an LBA-developed treatment plan updated at least every 6 months. MMC plans generally layer their own prior-authorization and reauthorization rules on top, so check with each plan individually.
Telehealth for direct ABA treatment is unsettled. The current eMedNY manual only allows LBA supervision of technicians and CBAAs via synchronous audio-video telehealth (on-site is still preferred); it doesn’t address telehealth delivery of direct ABA services to clients. The state’s Department of Health commissioned a formal evidence review on ABA-via-telehealth coverage, and as of its November 2025 meeting, its internal review was still ongoing, with no coverage decision finalized.
One billing quirk before you staff up: New York Medicaid doesn’t reimburse ABA delivered in a school setting. CBAAs and unlicensed technicians can’t bill Medicaid directly — the supervising LBA bills using their own NPI as billing and supervising provider, while the CBAA’s NPI appears only as rendering provider on CBAA-delivered services. Combined with the 1-LBA-to-6-tech supervision cap, that concentrates billing and supervisory load on your licensed staff.
Common Questions
What does New York Medicaid pay for CPT 97153?
New York Medicaid pays $14.45 per 15 minutes for 97153 (direct treatment by a technician). That is about $57.80 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 York 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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