South Carolina Medicaid ABA Reimbursement Rates (2026)
From official South Carolina Medicaid sources. Updated July 2026.
These are the published South 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.
South Carolina ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 0362T | Behavior identification supporting assessment, 2+ technicians (BB/BA modifiers, same rate) Category III code priced on SC ASD schedule. | $27.95 | per 15 min | 2026-07-01 | source |
| 0373T | Adaptive behavior treatment w/ protocol modification, 2+ technicians (BB/BA modifiers, same rate) Category III code priced on SC ASD schedule. | $30.00 | per 15 min | 2026-07-01 | source |
| 97151 | Behavior identification assessment (BCBA/BCBA-D mod BB or BCaBA mod BA, same rate) Rate unchanged; current schedule effective 7/1/2026 (was on 7/1/2024 doc). | $23.51 | per 15 min | 2026-07-01 | source |
| 97152 | Behavior identification supporting assessment (BB/BA staff-level modifiers, same rate) Rate unchanged; effective date updated to current 7/1/2026 schedule. | $20.50 | per 15 min | 2026-07-01 | source |
| 97153 | Adaptive behavior treatment by protocol (RBT/tech under BCBA; BB/BA modifiers, same rate) Rate unchanged since 7/1/2023 increase. Limit 160 units/week. | $14.88 | per 15 min | 2026-07-01 | source |
| 97154 | Group adaptive behavior treatment by protocol, performed by RBT (BB/BA modifiers, same rate) Rate unchanged; effective date updated to 7/1/2026 schedule. | $9.10 | per 15 min | 2026-07-01 | source |
| 97155 | Adaptive behavior treatment w/ protocol modification (BCBA; BB/BA modifiers, same rate; GT telehealth priced same) Rate unchanged. Limit 64 units/month. | $21.25 | per 15 min | 2026-07-01 | source |
| 97156 | Family adaptive behavior treatment guidance (BB/BA modifiers, same rate; GT telehealth priced same) Rate unchanged; effective date updated to 7/1/2026 schedule. | $21.25 | per 15 min | 2026-07-01 | source |
| 97157 | Multi-family group adaptive behavior treatment guidance (BB/BA modifiers, same rate) Published on SC schedule but missing from our data. | $13.31 | per 15 min | 2026-07-01 | source |
| 97158 | Group adaptive behavior treatment w/ protocol modification, performed by BCBA (BB/BA modifiers, same rate) Rate unchanged; effective date updated to 7/1/2026 schedule. | $13.00 | per 15 min | 2026-07-01 | source |
How South Carolina Compares
| Code | South Carolina | National median | Difference |
|---|---|---|---|
| 97151 | $23.51 | $29.14 | 19% below national median |
| 97153 | $14.88 | $15.00 | 1% below national median |
| 97155 | $21.25 | $24.18 | 12% below national median |
| 97156 | $21.25 | $22.50 | 6% below national median |
Market Context
South Carolina has had an autism insurance mandate since 2007. About 614,984 children in South Carolina are enrolled in Medicaid. Autism prevalence is 3.2% (2022 data). ProviderSpark lists 129 verified ABA provider locations in South Carolina.
Getting Paneled with Healthy Connections Medicaid
Because South Carolina has no state license for behavior analysts, enrollment runs on your BACB credential rather than a license number. The state’s ASD Services Provider Manual requires you to enroll as a BCBA-D, BCBA, or BCaBA in good standing with the BACB, and provider groups and schools must keep a qualification file on each practitioner (certification copy, an annually-updated SLED criminal record check, and employment verification).
- Get an NPI through NPPES.
- Confirm you meet South Carolina’s ASD provider qualifications per the ASD Services Provider Manual: BACB certification in good standing plus the qualification-file documents.
- Apply through the Healthy Connections Medicaid provider enrollment portal; screening includes a SLED criminal background check and, in some cases, a site visit.
- Submit within 30 days of getting your Reference ID (fax supporting documents to 803-870-9022, marked with that ID) — after 30 days the application is purged and you restart. Details at SCDHHS: Become a Provider.
- Separately credential with each managed care organization you want to be in-network with — Medicaid enrollment doesn’t auto-enroll you in any MCO’s network.
How South Carolina Delivers ABA
South Carolina runs Healthy Connections Medicaid as a hybrid: some members are served fee-for-service, others through managed care organizations — currently Absolute Total Care, Healthy Blue (BlueChoice), Humana Healthy Horizons, Molina Healthcare, and Select Health of South Carolina (First Choice). The published ASD fee schedule sets the FFS rate, but each MCO negotiates its own contracted rate and prior-authorization process, so your actual pay depends on which MCO a given client is enrolled in — and you won’t see those members unless you credential with that plan separately.
Billing Notes
ASD treatment requires prior authorization through SCDHHS’s contracted QIO, Acentra Health (portal scdhhs.acentra.com, phone 855-326-5219, fax 855-300-0082), using InterQual’s ABA Treatment Criteria. The Behavior Identification Assessment (97151) doesn’t need prior authorization, but treatment does — submit the BIA plus a Plan of Care. Approvals run six months; submit renewals 30 days before expiration but no later than 10 days before, or claims risk denial. Caps apply: 97153 is capped at 160 units per week per member across all providers, and 97155 at 10% of weekly therapy hours, up to 64 units per month. MCO members follow that plan’s own prior-auth policy instead of the FFS/Acentra process.
Telehealth is allowed only for established patients, synchronous audio/video, and specific codes. Only 97155 (protocol modification) and 97156 (family guidance) carry a priced telehealth (GT) rate, paid the same as in-person. Diagnostic tools (ADI-R, ADOS, CARS) aren’t considered valid for medical necessity by telehealth, so assessment work should stay in person. The GT modifier goes in the secondary position with your credential modifier (BB for BCBA/BCBA-D, BA for BCaBA) in the primary position, and it replaces the in-person visit rather than stacking on top of it.
Common Questions
What does South Carolina Medicaid pay for CPT 97153?
South Carolina Medicaid pays $14.88 per 15 minutes for 97153 (direct treatment by a technician). That is about $59.52 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 South 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.
Compare neighboring states: North Carolina · Georgia