Rhode Island Medicaid ABA Reimbursement Rates (2026)
From official Rhode Island Medicaid sources. Updated July 2026.
These are the published Rhode Island 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.
Rhode Island ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97151 (L9) | Behavior identification assessment – BCBA, supplemental-funding authorization (BHDDH adult DD) L9 = additional-funding authorization variant per DD Billing Manual 12/27/2024; rate matches U5 community rate. Verified in FFS tool. | $24.36 | per 15 min | 2024-07-01 | source |
| 97151 (U5) | Behavior identification assessment – BCBA, community/in-person (BHDDH adult DD programs only) Stored row had blank modifier and $30.00 – wrong. Official FFS tool + BHDDH FY25 Rate Table show $24.36 per 15 min, U5=community, max 32 units. Adult DD benefit (BHD011/MBD011-013), NOT a child-autism ABA rate. U2 (self-directed) variant same rate. | $24.36 | per 15 min | 2023-07-01 | source |
| 97151 (U6) | Behavior identification assessment – BCBA, telehealth (BHDDH adult DD programs only) Verified in EOHHS FFS search tool and BHDDH FY25 Rate Table. Max 32 units/day. | $20.01 | per 15 min | 2023-07-01 | source |
| H0032 (U5) | Behavior treatment plan development – BCaBA, community (BHDDH adult DD) BHDDH FY25 Rate Table: ‘Professional Services – BCaBA’, 15-min, max 32 units. Verified in FFS tool ($20.77 U5, eff 7/1/2023). | $20.77 | per 15 min | 2023-07-01 | source |
| H0032 (U6) | Behavior treatment plan development – BCaBA, telehealth (BHDDH adult DD) Verified in FFS tool and BHDDH FY25 Rate Table. | $16.77 | per 15 min | 2023-07-01 | source |
| H0046 | HBTS Lead Therapy (child ABA/HBTS, CEDARR program MCE025) Rate verified in FFS tool (10/1/2024 OHIC increase from $36.00). CEDARR crosswalk maps H0046 = HBTS Lead Therapy. Unit: EOHHS HBTS billing uses 15-min intervals; HCPCS description itself is unit-silent. Max 24 units. | $38.67 | per 15 min | 2024-10-01 | source |
| H0046 (HN) | HBTS clinical supervision – bachelors-level (child ABA/HBTS, CEDARR MCE025) Rate verified in FFS tool (up from $15.68). | $19.75 | per 15 min | 2024-10-01 | source |
| H0046 (HO) | HBTS clinical supervision – masters-level clinician incl. BCBA (child ABA/HBTS, CEDARR MCE025) Rate verified in FFS tool (up from $55.00 pre-10/1/2024). HO=masters level per CEDARR/HBTS standards; BCBA bills this tier. | $59.07 | per 15 min | 2024-10-01 | source |
| H0046 (HP) | HBTS clinical supervision – doctoral-level clinician (child ABA/HBTS, CEDARR MCE025) Rate verified in FFS tool (up from $65.00). | $69.81 | per 15 min | 2024-10-01 | source |
| H2014 (HO) | HBTS treatment consultation – masters-level clinician incl. BCBA (CEDARR MCE025) Code description states ‘per 15 minutes’. Verified in FFS tool (up from $27.50). Max 24 units. | $29.54 | per 15 min | 2024-10-01 | source |
| H2014 (HP) | HBTS treatment consultation – doctoral-level clinician (CEDARR MCE025) Verified in FFS tool (up from $32.50). | $34.91 | per 15 min | 2024-10-01 | source |
How Rhode Island Compares
| Code | Rhode Island | National median | Difference |
|---|---|---|---|
| 97151 (L9) | $24.36 | $29.14 | 16% below national median |
Market Context
Rhode Island has had an autism insurance mandate since 2011. About 119,157 children in Rhode Island are enrolled in Medicaid. Autism prevalence is 4.2% (2022 data). ProviderSpark lists 23 verified ABA provider locations in Rhode Island.
Getting Paneled with Rhode Island Medicaid
Rhode Island Medicaid runs through RIte Care for its managed-care population, but ABA is billed under a broader umbrella term: “Home-Based Therapeutic Services” (HBTS), which explicitly includes ABA. Look for HBTS, not just “ABA,” when searching enrollment or billing guidance.
- Submit your application electronically through the RI Medicaid Healthcare Portal (paper applications are no longer accepted except for attending physicians).
- Confirm your NPPES NPI record lists a current Rhode Island practice location, or an approved border community.
- Submit the required supplemental forms — EFT, W-9, and RI Medicaid Disclosures — on the EOHHS forms page.
- Check current status first: EOHHS placed a six-month moratorium on new HBTS/ABA provider enrollment starting June 16, 2026. Existing providers and pending applications are unaffected.
- For enrollment questions, call Gainwell Technologies Customer Service at (401) 784-8100.
How Rhode Island Delivers ABA
Rhode Island uses a hybrid delivery model. Most RIte Care members are enrolled with an MCO — Neighborhood Health Plan of Rhode Island (NHPRI), UnitedHealthcare Community Plan of Rhode Island, or Tufts Health Public Plan (THPP) — rather than pure fee-for-service. Your actual contracted rate is negotiated with each MCO separately; the state’s published fee schedule is a reference point, not necessarily what you’ll be paid. The most recent rate documentation, a June 2021 EOHHS addendum, lists Specialized Treatment/Treatment Support and Lead Therapy at $17.50 per 30-minute unit, Treatment Coordination at $8.75 per 15-minute unit, Clinical Supervision at $40/30-min unit (master’s-level) or $50 (doctoral-level), and Social Skills Group at $10.45/30-min unit. Those are notably low rates, and no newer fee schedule was confirmed. Budget conservatively and verify current numbers with each MCO before contracting.
Billing Notes
Prior authorization is required for HBTS/ABA reimbursement. Requests go to Gainwell Technologies Prior Authorization (fax 401-784-3892, or P.O. Box 2010, Warwick, RI 02887-2010) with supporting documentation. Standard requests get a response within 7 days; expedited or urgent requests within 72 hours. The certification standards also cap service intensity by phase: Phase 2 Specialized Treatment/Treatment Support tops out at 20 hours per week, so plan caseloads around that ceiling, not just authorization approval.
Telehealth billing for HBTS/ABA specifically is unconfirmed. Rhode Island has a general telemedicine parity law requiring in-network behavioral health telemedicine to pay no less than the in-person rate, but that law explicitly excludes Medicaid, so it does not guarantee telehealth parity for ABA/HBTS codes. Confirm with each MCO before billing telehealth units.
One billing quirk: if a member receives HBTS/ABA from more than one agency at once, the secondary agency must append an XP modifier to its billed codes (T1024, T1016, H0046, H0046-HO, H0046-HP, S9446) to avoid duplicate-billing denials. The family designates one agency as case-management lead.
Common Questions
What does Rhode Island Medicaid pay for CPT 97153?
See the rate table above for the codes Rhode Island 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 Rhode Island 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: Massachusetts · Connecticut