North Carolina Medicaid ABA Reimbursement Rates (2026)
From official North Carolina Medicaid sources. Updated July 2026.
These are the published North Carolina 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.
North Carolina ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97151 | RB-BHT Comprehensive Assessment (behavior identification assessment) Rate value verified unchanged; effective date corrected from 2024-01-01 to 2025-10-01 (restored-rate schedule posted 1/5/2026, retro to DOS 10/1/2025). Equals 2019 rate $26.56 x 1.15 (2024 increase). No practitioner tier — flat rate regardless of licensure. | $30.56 | per 15 min | 2025-10-01 | source |
| 97152 | RB-BHT Assessment Follow-Up (behavior identification supporting assessment) We lacked this row. NCDHHS flags this rate as ~3x national average and slated for re-evaluation — likely to change. 2019 base $53.65 x 1.15. | $61.73 | per 15 min | 2025-10-01 | source |
| 97153 | RB-BHT ABA Intervention – Individual (adaptive behavior treatment by protocol) Rate verified; effective date corrected to 2025-10-01 (restoration schedule). Was cut 10% on 10/1/2025 then restored retroactively Jan 2026. | $20.81 | per 15 min | 2025-10-01 | source |
| 97154 | RB-BHT ABA Intervention – Group (group adaptive behavior treatment by protocol) Rate verified (priced per 15 min per beneficiary); effective date corrected to 2025-10-01. NC descriptor is ‘RBI-BHT ABA>2’. | $11.37 | per 15 min | 2025-10-01 | source |
| 97155 | RB-BHT Supervision/Observation and Direction (adaptive behavior treatment with protocol modification) Rate verified; effective date corrected to 2025-10-01. Dropped ‘(BCBA)’ tier tag from description — NC pays one flat rate with no licensure tiering. | $32.22 | per 15 min | 2025-10-01 | source |
| 97156 | RB-BHT Family Training – Individual (family adaptive behavior treatment guidance) Rate verified; effective date corrected to 2025-10-01. No practitioner tier. | $23.70 | per 15 min | 2025-10-01 | source |
| 97157 | RB-BHT Family Training – Group (multiple-family group adaptive behavior treatment guidance) We lacked this row. Seventh covered RB-BHT code. 2019 base $10.00 x 1.15. | $11.51 | per 15 min | 2025-10-01 | source |
How North Carolina Compares
| Code | North Carolina | National median | Difference |
|---|---|---|---|
| 97151 | $30.56 | $29.14 | 5% above national median |
| 97153 | $20.81 | $15.00 | 39% above national median |
| 97155 | $32.22 | $24.18 | 33% above national median |
| 97156 | $23.70 | $22.50 | 5% above national median |
Market Context
North Carolina has had an autism insurance mandate since 2015. About 1,432,431 children in North Carolina are enrolled in Medicaid. Autism prevalence is 3.6% (2022 data). ProviderSpark lists 277 verified ABA provider locations in North Carolina.
Getting Paneled with NC Medicaid
ABA is covered under the Research-Based Behavioral Health Treatment (RB-BHT) benefit, Clinical Coverage Policy No. 8F, for beneficiaries under 21 with autism. LME/MCOs no longer credential behavioral health providers directly — enrollment runs through one statewide system.
- Confirm eligibility (in-state, or within 40 miles of the border) at NCTracks enrollment basics. Session Law 2026-1 bars new out-of-state BCBA/QASP Supervisor applications submitted on or after April 30, 2026.
- Enroll directly through NCTracks, required even for state-funded-only services.
- Complete the Provider Enrollment Application with the BCBA taxonomy code (103K00000X), certification number, and NC license.
- Sign the DHHS Provider Administrative Participation Agreement and complete risk screening (see the enrollment FAQ).
- For beneficiaries on a Tailored Plan, coordinate network status with their LME/MCO.
How North Carolina Delivers ABA
North Carolina runs a hybrid model. Some beneficiaries are covered under NC Medicaid Direct; others are on a Tailored Plan managed by one of four regional LME/MCOs: Alliance Health, Partners Health Management, Trillium Health Resources, or Vaya Total Care. Which one applies depends on the client’s county, and determines who you coordinate authorizations with.
The rate you actually collect has been a moving target. NC Medicaid cut ABA and RB-BHT rates by as much as 10% starting October 1, 2025, during a budget shortfall. Twenty-one families sued, and a Wake County judge issued a preliminary injunction on November 10, 2025. Governor Stein ordered rates restored to September 30, 2025 levels effective December 10, 2025; the restored fee schedule posted January 5, 2026 — CPT 97153 back to $20.81 per 15 minutes, 97155 to $32.22 per 15 minutes — with plans given 30 more days to reprocess claims.
Billing Notes
Prior authorization is required for every RB-BHT/ABA service, aside from retroactive eligibility periods. Initial and reauthorization both run up to 180 calendar days based on an LQASP treatment plan, submitted before the prior one expires, through the DHHS Utilization Review Contractor or the beneficiary’s LME-MCO.
Telehealth is currently allowed for select services under Policy 8F’s general telehealth rules, plus limited audio-only delivery — but that’s tightening. Session Law 2026-1 directs DHHS to bar paraprofessional-delivered telehealth absent a documented exception, require in-person LQASP assessments, and cap LQASP telehealth supervision at 50% of a beneficiary’s LQASP-delivered services. Parent and caregiver training by an LQASP stays telehealth-eligible either way.
An LQASP must observe or direct a paraprofessional for at least 10% of that paraprofessional’s billed services, with a signed service note for every contact. Session Law 2026-1 layers on requirements DHHS hasn’t yet folded into the posted policy: an RBT/ABAT mandate after a 120-day grace period, a required LQASP-to-paraprofessional ratio past 200 billed hours in six months, and graduated recoupment or suspension for noncompliance. Expect billing guidance to keep shifting through 2026.
Common Questions
What does North Carolina Medicaid pay for CPT 97153?
North Carolina Medicaid pays $20.81 per 15 minutes for 97153 (direct treatment by a technician). That is about $83.24 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 North Carolina 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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