Oregon Medicaid ABA Reimbursement Rates (2026)
From official Oregon Medicaid sources. Updated July 2026.
These are the published Oregon 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.
Oregon ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97151 | Behavior identification assessment and plan of care Published unrounded as 20.84544. Rate unchanged from stored value; effective/schedule date advanced to Feb 2026 publication. Only ABA code NOT requiring PA. Managed through RR. | $20.85 | per 15 min | 2026-02-01 | source |
| 97152 | Behavior identification-supporting assessment by technician Published unrounded as 19.81144. Rate unchanged; schedule date advanced to Feb 2026. | $19.81 | per 15 min | 2026-02-01 | source |
| 97153 | Adaptive behavior treatment by protocol, by technician Published unrounded as 14.70348. Rate unchanged; schedule date advanced to Feb 2026. PA required. | $14.70 | per 15 min | 2026-02-01 | source |
| 97154 | Group adaptive behavior treatment by protocol, by technician Published unrounded as 13.72118. Priced per 15 min PER RECIPIENT. Rate unchanged; schedule date advanced to Feb 2026. PA required. | $13.72 | per 15 min | 2026-02-01 | source |
| 97155 | Adaptive behavior treatment with protocol modification (QHP) Published unrounded as 32.07468. Rate unchanged; schedule date advanced to Feb 2026. PA required. | $32.07 | per 15 min | 2026-02-01 | source |
| 97156 | Family adaptive behavior treatment guidance, single family Published unrounded as 32.07468 (same as 97155). Rate unchanged; schedule date advanced to Feb 2026. PA required. | $32.07 | per 15 min | 2026-02-01 | source |
| 97157 | Multiple-family group adaptive behavior guidance, per family Published unrounded as 8.67526; priced per 15 min PER FAMILY. Rate unchanged; schedule date advanced to Feb 2026. PA required. | $8.68 | per 15 min | 2026-02-01 | source |
How Oregon Compares
| Code | Oregon | National median | Difference |
|---|---|---|---|
| 97151 | $20.85 | $29.14 | 28% below national median |
| 97153 | $14.70 | $15.00 | 2% below national median |
| 97155 | $32.07 | $24.18 | 33% above national median |
| 97156 | $32.07 | $22.50 | 43% above national median |
Market Context
Oregon has had an autism insurance mandate since 2007. About 472,211 children in Oregon are enrolled in Medicaid. Autism prevalence is 4.3% (2022 data). ProviderSpark lists 39 verified ABA provider locations in Oregon.
Getting Paneled with Oregon Health Plan (OHP)
Oregon Medicaid, branded as OHP, mixes fee-for-service with regional Coordinated Care Organizations (CCOs). Roughly 10% of members stay on the fee-for-service “Open Card,” and the rest route through their local CCO. To bill ABA in Oregon, you enroll with the state first, then separately credential with each CCO covering the clients you plan to treat:
- Verify your NPI isn’t already enrolled, using the MMIS NPI validation tool
- Confirm your correct Oregon Medicaid provider type and specialty code (behavior analyst vs. technician) before you apply
- Create an account and complete your application in the MMIS Provider Portal (Firefox or Edge only)
- Work through the step-by-step enrollment guide and submit the required forms online instead of by fax
- Separately credential and contract with each relevant Coordinated Care Organization (CCO) to bill for members enrolled in that plan
How Oregon Delivers ABA
Oregon runs a hybrid Medicaid model. Most members are assigned to one of twelve CCOs: Advanced Health, AllCare CCO, Cascade Health Alliance, Columbia Pacific CCO, Eastern Oregon CCO, Health Share of Oregon, InterCommunity Health Network CCO, Jackson Care Connect, PacificSource Community Solutions, Trillium Community Health Plan, Umpqua Health Alliance, and Yamhill Community Care. The remaining members are fee-for-service. In practice, this means the rate you get paid, your prior-authorization process, and even which network you’re credentialed with depends on which CCO covers each specific client, not one statewide Medicaid rate. Confirm each new client’s CCO before you start treatment, since prior auth and billing route through that CCO rather than the state for most members.
Billing Notes
ABA requires prior authorization in Oregon for members diagnosed with autism spectrum disorder and for those with stereotyped movement disorder with self-injurious behavior. PA requires a qualifying evaluation under OAR 410-172-0770 (an ASD diagnosis on the HERC Prioritized List, a standardized tool such as ADOS, documentation of DSM-5 core features, a caregiver interview, direct observation, and required medical, developmental, and hearing screens), plus a treatment plan under OAR 410-172-0650 prepared by a licensed health care professional, an LBA or LABA, or a BARB declaration holder.
OHA covers telehealth for behavioral health services to the same extent as in-person care under OAR 410-172-0850, including phone, email, and videoconferencing, subject to HIPAA-compliant technology and documentation requirements.
One billing quirk worth knowing before you schedule staff: per OHA’s January 2024 provider bulletin, technician code 97153 and supervising-professional code 97155 can only be billed concurrently if the concurrent treatment is medically necessary and appropriate, the technician is working within scope, the professional is providing appropriate targeted supervision, and the combined concurrent activity doesn’t exceed four units, or one hour, with documentation required under OAR 410-172-0620.
Common Questions
What does Oregon Medicaid pay for CPT 97153?
Oregon Medicaid pays $14.70 per 15 minutes for 97153 (direct treatment by a technician). That is about $58.80 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 Oregon 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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