Tennessee Medicaid ABA Reimbursement Rates (2026)

From TennCare and MCO provider documentation. Updated July 2026.

Why There Is No Published Tennessee Fee Schedule

Under an at-risk managed care model, the state pays each MCO a capitated amount and the MCO decides what it pays providers. Your ABA rate in Tennessee is whatever your contract’s fee exhibit says — two practices billing the same code in the same city can be paid differently. To see real numbers, you have to credential with each MCO and negotiate.

Where Tennessee ABA Rates Actually Come From

Enroll with TennCare, then credential with each MCO. Your payable rates live in the fee exhibit of each contract — that is the document to negotiate. Start here: TennCare managed care organizations (tn.gov) · UnitedHealthcare TennCare ABA program description (PDF) · Wellpoint Tennessee ABA provider requirements (PDF).

National Benchmarks for Contract Negotiation

With no published state schedule, the most useful anchor is what other state Medicaid programs publish for the same codes. National medians across published fee schedules:

Market Context

Tennessee has had an autism insurance mandate since 2006. About 840,241 children in Tennessee are enrolled in Medicaid. Autism prevalence is 3.1% (2022 data). ProviderSpark lists 140 verified ABA provider locations in Tennessee.

Getting Paneled with TennCare

Tennessee does not run a single Medicaid enrollment desk for ABA. You register with the state, then credential and contract separately with the MCO or MCOs you want to bill.

• Get a National Provider Identifier through NPPES.
• Register through the TennCare Provider Registration Portal (PDMS) to get or update a TennCare Medicaid ID.
• Attest your profile through CAQH ProView. TennCare only processes providers whose CAQH ID shows “attested” status.
• Credential and contract directly with at least one TennCare managed care organization.
• Get final enrollment approval once your CAQH-attested data reaches TennCare, then revalidate every 3 years to avoid termination.

How Tennessee Delivers ABA

TennCare is a managed care program, not fee-for-service. There is no single statewide ABA rate to look up. Instead, three MCOs each contract and pay separately: BlueCare Tennessee (Volunteer State Health Plan, a BlueCross BlueShield of Tennessee affiliate), UnitedHealthcare Community Plan of Tennessee, and Wellpoint Tennessee (formerly Amerigroup Tennessee). TennCare Select, operated by BlueCare under a separate contract, covers special populations like SSI children under 21, foster care youth, and IDD members through SelectCommunity.

Because rates are negotiated per MCO rather than set by the state, what you actually get paid depends on which MCO or MCOs you contract with, not on a single published TennCare fee schedule.

Billing Notes

ABA requires pre-certification and prior authorization from the member’s MCO: documentation from a TN-licensed clinician supporting medical necessity, plus a time-limited treatment plan built by the BCBA, dated within 30 days of the start date, with defined target behaviors, baseline data, and measurable progress criteria. Continued services need ongoing reassessment showing progress.

Telehealth is conditionally reimbursable, not blanket-excluded. TennCare’s ABA program description treats it as a permissible option but expects providers to weigh limitations like interstate licensure, safety, privacy, and technology access, and to confirm HIPAA-compliant tech before using it. No ABA-specific telehealth modifiers or session-percentage cap were specified.

The billing quirk to know: CPT 97153 is coded “BA” when a BCBA or LBA delivers the service, and “RBT” when a technician delivers it, while 97154 covers group treatment. Non-covered items include non-client-specific prep, report-writing, and supervision/training time; provider travel; billing while the member is asleep; time spent with other providers or school staff; services that are part of an IEP or school aide role; and services billed simultaneously with OT, PT, speech, or psychotherapy for the same time block. If a claim is denied, you go first to the MCO’s appeal process, then to the TennCare Oversight Division’s independent review process, which must be requested within 365 days of the first denial.

Common Questions

What does Tennessee Medicaid pay for CPT 97153?

There is no single published rate — each TennCare managed care organization negotiates its own. As a benchmark, the national median published Medicaid rate is $15.00 per 15 minutes (about $60.00 per hour).

Which plans run TennCare’s ABA benefit?

BlueCare Tennessee, UnitedHealthcare Community Plan, and Wellpoint (formerly Amerigroup). Providers credential with each plan separately; rates and prior-authorization rules are set plan by plan.

Does TennCare cover ABA at all?

Yes. ABA is covered for members under 21 under EPSDT, with prior authorization through the member’s managed care organization.

Compare neighboring states: Georgia · Alabama · Kentucky · North Carolina · Virginia