Ohio Medicaid ABA Reimbursement Rates (2026)
From official Ohio Medicaid sources. Updated July 2026.
Ohio ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 0362T | Exposure behavior identification supporting assessment PROPOSED rate from draft Appendix A (unadopted rule 5160-34-03). | $33.54 (est.) | per 15 min | — | source |
| 0373T | Exposure adaptive behavior treatment with protocol modification PROPOSED rate from draft Appendix A (unadopted rule 5160-34-03). | $33.54 (est.) | per 15 min | — | source |
| 97151 (BCaBA) | Behavior identification assessment – BCaBA PROPOSED rate from same draft Appendix A (unadopted rule 5160-34-03). Second practitioner tier. | $22.67 (est.) | per 15 min | — | source |
| 97151 (IASP) | Behavior identification assessment – Independent Adaptive Services Practitioner PROPOSED rate only. Source is draft Appendix A to proposed OAC rule 5160-34-03 (stamped DRAFT – NOT FOR FILING). Rule never filed/adopted: Register of Ohio shows zero filings for 5160-34-03; codes.ohio.gov has no chapter 5160-34. Stored ‘confirmed, effective 2024-01-01’ was wrong — no adopted FFS rate exists. Tier label corrected from ‘BCBA’ to state’s ‘Independent Adaptive Services Practitioner’. | $30.49 (est.) | per 15 min | — | source |
| 97152 (RBT) | Behavior identification supporting assessment – RBT PROPOSED rate from draft Appendix A (unadopted rule 5160-34-03). | $17.00 (est.) | per 15 min | — | source |
| 97153 (RBT) | Adaptive behavior treatment by protocol – RBT PROPOSED rate from draft Appendix A to unadopted rule 5160-34-03. Not on any effective Ohio FFS fee schedule (Appendix DD 07/01/2025 omits 9715x codes). Effective date removed; downgraded from confirmed. | $16.04 (est.) | per 15 min | — | source |
| 97154 (RBT) | Group adaptive behavior treatment by protocol – RBT PROPOSED rate from draft Appendix A (unadopted rule 5160-34-03). | $7.61 (est.) | per 15 min | — | source |
| 97155 (BCaBA) | Adaptive behavior treatment with protocol modification – BCaBA PROPOSED rate from draft Appendix A (unadopted rule 5160-34-03). | $20.63 (est.) | per 15 min | — | source |
| 97155 (IASP) | Adaptive behavior treatment with protocol modification – Independent Adaptive Services Practitioner PROPOSED rate from draft Appendix A to unadopted rule 5160-34-03. Downgraded from confirmed; tier label corrected to state’s IASP term. | $27.28 (est.) | per 15 min | — | source |
| 97156 (BCaBA) | Family adaptive behavior treatment guidance – BCaBA PROPOSED rate from draft Appendix A (unadopted rule 5160-34-03). | $22.37 (est.) | per 15 min | — | source |
| 97156 (IASP) | Family adaptive behavior treatment guidance – Independent Adaptive Services Practitioner PROPOSED rate from draft Appendix A to unadopted rule 5160-34-03. Downgraded from confirmed; tier label corrected to state’s IASP term. | $30.09 (est.) | per 15 min | — | source |
| 97157 (BCaBA) | Multiple-family adaptive behavior treatment guidance – BCaBA PROPOSED rate from draft Appendix A (unadopted rule 5160-34-03). | $10.62 (est.) | per 15 min | — | source |
| 97157 (IASP) | Multiple-family adaptive behavior treatment guidance – Independent Adaptive Services Practitioner PROPOSED rate from draft Appendix A (unadopted rule 5160-34-03). | $14.46 (est.) | per 15 min | — | source |
| 97158 (BCaBA) | Group adaptive behavior treatment with protocol modification – BCaBA PROPOSED rate from draft Appendix A (unadopted rule 5160-34-03). | $10.62 (est.) | per 15 min | — | source |
| 97158 (IASP) | Group adaptive behavior treatment with protocol modification – Independent Adaptive Services Practitioner PROPOSED rate from draft Appendix A to unadopted rule 5160-34-03. Per 15-min unit per rendering practitioner; group ratio capped at 1:8 in draft rule. Downgraded from confirmed. | $14.46 (est.) | per 15 min | — | source |
How Ohio Compares
| Code | Ohio | National median | Difference |
|---|---|---|---|
| 97151 (BCaBA) | $22.67 | $29.14 | 22% below national median |
| 97153 (RBT) | $16.04 | $15.00 | 7% above national median |
| 97155 (BCaBA) | $20.63 | $24.18 | 15% below national median |
| 97156 (BCaBA) | $22.37 | $22.50 | 1% below national median |
Market Context
Ohio has had an autism insurance mandate since 2017. About 1,192,630 children in Ohio are enrolled in Medicaid. Autism prevalence is 3.6% (2022 data). ProviderSpark lists 167 verified ABA provider locations in Ohio.
Getting Paneled with Ohio Medicaid
Ohio Medicaid has no separate consumer brand name — it’s administered directly by the Ohio Department of Medicaid (ODM). Since October 2022, every step of enrollment runs through one electronic portal, the Provider Network Management (PNM) module, with no paper applications accepted.
- Get the underlying credential first: BCBA/BCBA-D through the BACB, or COBA through the Ohio Board of Psychology, for independent practitioners; RBT or BCaBA for dependent practitioners. Organizational providers also need an active ODM provider agreement. See Ohio Revised Code Chapter 4783.
- Create an OH|ID account, Ohio’s single sign-on system, needed to access PNM.
- Submit your enrollment application through PNM. Applications expire if not completed within 10 days. Approval issues a 7-digit ODM provider number.
- Separately join the network of each Medicaid managed care organization you want to bill — and OhioRISE/Aetna for youth with complex needs — since most enrollees are in managed care. ODM’s centralized credentialing cuts duplicate paperwork, but network contracting is a separate step from ODM enrollment.
- For enrollment help, contact the ODM Integrated Help Desk at 800-686-1516 or IHD@medicaid.ohio.gov.
How Ohio Delivers ABA
Ohio runs a hybrid delivery model. An ODM provider number doesn’t mean you can bill every client — most enrollees are covered through one of seven MCOs: AmeriHealth Caritas Ohio, Anthem Blue Cross and Blue Shield, Buckeye Health Plan, CareSource, Humana Healthy Horizons in Ohio, Molina Healthcare of Ohio, and UnitedHealthcare Community Plan of Ohio. There’s also OhioRISE, run by Aetna Better Health of Ohio, a carve-in plan for youth with complex, multi-system needs. The rate you get paid depends on which plan your client is enrolled in and whether you’ve contracted with that specific MCO, not just your ODM enrollment status.
Billing Notes
Prior authorization is required at three points: an assessment or reassessment exceeding 10 hours per 180 days, the start of treatment, and continuing treatment beyond the initial 180-day PA period, which needs progress documentation through periodic reassessment. CareSource’s current policy confirms a medical-necessity review at baseline and every 6 months after.
Telehealth is allowed with conditions. Parent and caregiver training, and clinical supervision, can be delivered via telehealth. One-on-one ABA can also be delivered via telehealth when medically necessary and documented — an earlier exclusion on 1:1 telehealth ABA was removed effective April 12, 2023. Payers can still request supervision documentation for telehealth sessions.
One billing quirk: claims won’t be accepted without treatment documentation submitted before the claim, including the behavior treatment plan, functional assessments, and daily service and progress notes. CareSource’s policy also applies CMS daily-unit caps by CPT code — 97153 caps at 32 units, 97155 at 24 — and requires each claim line to specify a single date of service.
Common Questions
What does Ohio Medicaid pay for CPT 97153?
See the rate table above for the codes Ohio publishes.
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 Ohio 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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