North Dakota Medicaid ABA Reimbursement Rates (2026)
From official North Dakota Medicaid sources. Updated July 2026.
These are the published North Dakota 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 Dakota ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 0373T | Adaptive behavior treatment w/ protocol modification, destructive behavior (technician face-to-face time) ND covers this Category III code at $12.74/15min in both the 7/1/2025 autism schedule and Feb 2026 professional schedule. Covered through age 20 only; service auth required. Codes 97157, 97158, 0362T are NOT covered ($0.00, Covered=No). | $12.74 | per 15 min | 2025-07-01 | source |
| 97151 | Behavior identification assessment by QHP Verified $31.14/15min in 7/1/2025 Autism Fee Schedule and Feb 2026 Professional Fee Schedule (Autism category). Covered through age 20 only; enrolled ABA providers; service auth required; telehealth allowed. | $31.14 | per 15 min | 2025-07-01 | source |
| 97152 | Behavior ID supporting assessment by technician Verified $23.05/15min in both 7/1/2025 autism schedule and Feb 2026 professional schedule. | $23.05 | per 15 min | 2025-07-01 | source |
| 97153 | Adaptive behavior treatment by protocol (technician) Verified $10.60/15min in both official documents. No practitioner tiers. | $10.60 | per 15 min | 2025-07-01 | source |
| 97154 | Group adaptive behavior treatment by technician Verified $2.67/15min (group code, low per-15-min rate as published by the state; schedule note says ‘multiple patients’). | $2.67 | per 15 min | 2025-07-01 | source |
| 97155 | Adaptive behavior treatment w/ protocol modification (QHP) Verified $31.14/15min in both official documents. | $31.14 | per 15 min | 2025-07-01 | source |
| 97156 | Family adaptive behavior treatment guidance (QHP) Verified $28.90/15min in both official documents. | $28.90 | per 15 min | 2025-07-01 | source |
How North Dakota Compares
| Code | North Dakota | National median | Difference |
|---|---|---|---|
| 97151 | $31.14 | $29.14 | 7% above national median |
| 97153 | $10.60 | $15.00 | 29% below national median |
| 97155 | $31.14 | $24.18 | 29% above national median |
| 97156 | $28.90 | $22.50 | 28% above national median |
Market Context
North Dakota has had an autism insurance mandate since 2017. About 51,519 children in North Dakota are enrolled in Medicaid. Autism prevalence is 2.3% (2022 data). ProviderSpark lists 18 verified ABA provider locations in North Dakota.
Getting Paneled with ND Medicaid — Autism Applied Behavior Analysis (ABA) Service
North Dakota doesn’t have a branded Medicaid ABA program like Medi-Cal or TennCare — it’s simply “ND Medicaid,” and the Autism ABA benefit is enrolled through the state’s Noridian-administered MMIS portal. Steps to get paneled:
- Search existing enrollment by NPI or name in the provider enrollment portal to confirm you or your agency aren’t already enrolled.
- Complete the online application through the ND Health Enterprise MMIS Web Portal.
- Gather documentation: the ABA Group Application Requirements packet, IRS EIN verification, NPI, license/certification details, ownership and management info, and exclusion/sanction disclosures — details are outlined on the enrollment information page.
- Submit through the MMIS portal for review by Noridian Healthcare Solutions, ND Medicaid’s enrollment contractor.
- Direct questions to ND Medicaid Provider Enrollment (Noridian) at (877) 328-7098 or (701) 328-7098 option 1, Monday-Friday 8am-5pm CT, or NDMedicaidEnrollment@noridian.com.
How North Dakota Delivers ABA
ND Medicaid pays for Autism ABA directly, fee-for-service — there’s no managed care organization sitting between you and the state for this benefit. That means one rate schedule and one set of rules to learn, rather than negotiating separately with multiple MCOs the way providers do in many other states.
Billing Notes
Getting a client authorized takes two steps. First, the family submits an ASD diagnosis plus a Health Tracks/EPSDT screening (completed within the last 6 months) whose recommendation supports ABA, and the state issues an approval letter. Then your agency submits a Service Authorization request twice a year: an annual medical-necessity review tied to a fresh Health Tracks screening, and a 180-day care-plan reassessment — each one requiring a BCBA-signed care plan with measurable goals, baseline data, and progress graphs.
Telehealth is generally billable. ND Medicaid’s telehealth policy lists behavioral health services among those deliverable by synchronous audio-video, or audio-only with documented justification, as long as the provider and member are enrolled/eligible, the platform is HIPAA-compliant, and the specific procedure code is confirmed telehealth-eligible.
One billing quirk to know: if your agency provides both speech-language pathology and Autism ABA to the same client, only one of the two services can be billed per day. ND Medicaid also won’t pay for ABA components that are experimental, unrelated to the child’s diagnosis or functional limitations, purely vocational, educational, recreational, or social, or that duplicate another Medicaid service — and punishment procedures that add or remove a stimulus are, in most cases, denied in the care plan.
Common Questions
What does North Dakota Medicaid pay for CPT 97153?
North Dakota Medicaid pays $10.60 per 15 minutes for 97153 (direct treatment by a technician). That is about $42.40 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 North Dakota 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.
Compare neighboring states: Minnesota · South Dakota · Montana