South Dakota Medicaid ABA Reimbursement Rates (2026)
From official South Dakota Medicaid sources. Updated July 2026.
These are the published South 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.
South Dakota ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97151 | Behavior identification assessment by professional Stored estimate $22.00 was wrong; official SFY27 rate $35.63 per 15 min, rate updated 7/1/2026. | $35.63 | per 15 min | 2026-07-01 | source |
| 97152 | Behavior identification supporting assessment, by technician Rate updated 7/1/2026. | $21.73 | per 15 min | 2026-07-01 | source |
| 97153 | Adaptive behavior treatment by protocol, by technician Stored estimate $12.00 was wrong; official SFY27 rate $21.73 per 15 min, rate updated 7/1/2026. | $21.73 | per 15 min | 2026-07-01 | source |
| 97154 | Group adaptive behavior treatment by protocol, by technician (multiple patients) Group code; low per-15-min rate is consistent with per-participant pricing. Manual: group treatment billed with the appropriate modifier. | $5.44 | per 15 min | 2026-07-01 | source |
| 97155 | Adaptive behavior treatment with protocol modification, by professional Stored estimate $22.00 was wrong; official SFY27 rate $39.00 per 15 min, rate updated 7/1/2026. | $39.00 | per 15 min | 2026-07-01 | source |
| 97156 | Family adaptive behavior treatment guidance, by professional Rate last updated 7/1/2025 per the state’s ‘Rate Updated Date’ column; unchanged in the SFY27 schedule. | $22.44 | per 15 min | 2025-07-01 | source |
| 97157 | Multiple-family group adaptive behavior treatment guidance, by professional Rate updated 7/1/2026. | $13.01 | per 15 min | 2026-07-01 | source |
| 97158 | Group adaptive behavior treatment with protocol modification, by professional Rate updated 7/1/2026. | $13.01 | per 15 min | 2026-07-01 | source |
How South Dakota Compares
| Code | South Dakota | National median | Difference |
|---|---|---|---|
| 97151 | $35.63 | $29.14 | 22% above national median |
| 97153 | $21.73 | $15.00 | 45% above national median |
| 97155 | $39.00 | $24.18 | 61% above national median |
| 97156 | $22.44 | $22.50 | 0% above national median |
Market Context
South Dakota has had an autism insurance mandate since 2015. About 76,908 children in South Dakota are enrolled in Medicaid. Autism prevalence is 2.6% (2022 data). ProviderSpark lists 18 verified ABA provider locations in South Dakota.
Getting Paneled with South Dakota Medicaid
South Dakota Medicaid runs ABA as straight fee-for-service, so there’s no managed care plan to panel with — just the state program. Here’s the enrollment path:
- Confirm the servicing behavior analyst’s NPI is enrolled with South Dakota Medicaid. RBTs and BCaBAs can’t enroll directly — they bill under a supervising, enrolled, licensed behavior analyst. See the ABA billing manual.
- Review the Provider Enrollment Chart, then enroll (or update an existing record) through the Provider Enrollment (PE) Portal — all SD Medicaid enrollment has run through this portal since May 2021.
- Eligible ordering, referring, and attending providers may need no further action beyond enrollment, since submitting a claim itself constitutes agreement to the SD Medicaid Provider Agreement. Enrolled providers manage claims, eligibility, and reports through the separate Medicaid Portal.
- Make sure the client has an ASD diagnosis (physician or psychologist, dated within the last 12 months) and an order for ABA services from a physician, NP, PA, or the client’s Care Management provider before requesting services.
- File the ABA Services Prior Authorization Form with supporting diagnostic and treatment-plan documentation for each 6-month authorization period.
How South Dakota Delivers ABA
There’s no MCO layer and no separate managed-care rate to negotiate. What you’re paid is the lesser of your usual-and-customary charge or the state’s published ABA fee schedule, set directly by the state rather than filtered through a private plan.
Billing Notes
Prior authorization is required before any ABA services begin, granted in 6-month blocks — you’ll re-authorize every 6 months with updated progress documentation and, for reassessments, certification that services remain medically necessary. Requests need the PA form, an ASD diagnosis using a named instrument (Gilliam Autism Rating Scale-3, Autism Diagnostic Observation Schedule-2, or Adaptive Behavior Assessment System), a copy of that instrument, objective progress criteria, a recommended weekly service amount by CPT code, and a discharge plan if services are expected to end within 6 months of reauthorization.
Telehealth is allowed for ABA delivered through a real-time interactive system, but the supervising BCBA still has to complete an in-person visit within the first 30 days and at least every 90 days after that.
The billing quirk worth knowing: technician-level codes are capped at CPT 97152-97154 and must be billed under the supervising, enrolled analyst’s NPI — RBTs and BCaBAs can’t bill independently. Several categories are explicitly non-covered, including data recording/documentation time, educational or vocational/recreational services, play therapy, activities-of-daily-living help beyond care-plan goals, travel time, and services delivered by a parent or guardian — a gotcha since some of that work happens as part of normal service delivery. Timely filing is 6 months from the month of service; reconsideration requests are due within 3 months of a denial.
Common Questions
What does South Dakota Medicaid pay for CPT 97153?
South Dakota Medicaid pays $21.73 per 15 minutes for 97153 (direct treatment by a technician). That is about $86.92 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 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.
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