Texas Medicaid ABA Reimbursement Rates (2026)
From official Texas Medicaid sources. Updated July 2026.
These are the published Texas 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.
Texas ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97151 (HO) | Behavior identification assessment | $27.56 | per 15 min | 2025-09-01 | source |
| 97153 | Adaptive behavior treatment by protocol Raised from $13.00. Same rate for all credential levels. | $14.50 | per 15 min | 2025-09-01 | source |
| 97155 (HN) | Adaptive behavior treatment w/ protocol modification (BCaBA) HN = bachelor’s-level BCaBA | $20.08 | per 15 min | 2025-09-01 | source |
| 97155 (HO) | Adaptive behavior treatment w/ protocol modification (BCBA) HO = master’s-level BCBA | $25.10 | per 15 min | 2025-09-01 | source |
| 97156 (HN) | Family adaptive behavior treatment guidance (BCaBA) HN = bachelor’s-level BCaBA | $18.40 | per 15 min | 2025-09-01 | source |
| 97156 (HO) | Family adaptive behavior treatment guidance (BCBA) HO = master’s-level BCBA | $23.01 | per 15 min | 2025-09-01 | source |
| 97158 (HN) | Group adaptive behavior treatment (BCaBA) Group code, billed per participant per 15 min (groups of 2-8) — deliberately held flat at the 9/1/2025 rate review while individual codes rose ~11.5%. | $2.25 | per 15 min | 2024-03-01 | source |
| 97158 (HO) | Group adaptive behavior treatment (BCBA) Group code, billed per participant per 15 min (groups of 2-8) — deliberately held flat at the 9/1/2025 rate review while individual codes rose ~11.5%. | $2.81 | per 15 min | 2024-03-01 | source |
How Texas Compares
| Code | Texas | National median | Difference |
|---|---|---|---|
| 97151 (HO) | $27.56 | $29.14 | 5% below national median |
| 97153 | $14.50 | $15.00 | 3% below national median |
| 97155 (HO) | $25.10 | $24.18 | 4% above national median |
| 97156 (HO) | $23.01 | $22.50 | 2% above national median |
Market Context
Texas has had an autism insurance mandate since 2007. About 3,169,115 children in Texas are enrolled in Medicaid. Autism prevalence is 3.2% (2022 data). ProviderSpark lists 637 verified ABA provider locations in Texas.
Getting Paneled with Texas Medicaid
Texas Medicaid covers ABA as an Autism Services benefit inside the Texas Health Steps-Comprehensive Care Program (THSteps-CCP), for Medicaid recipients age 20 and younger with an autism spectrum disorder diagnosis. Depending on eligibility category, managed-care members are enrolled in STAR, STAR Kids, or STAR Health.
- Get an individual NPI from CMS using taxonomy code 103K00000X, the LBA taxonomy (TMHP enrollment guide).
- Hold a current, active, unrestricted LBA license from TDLR — you can’t enroll if it expires within 30 days.
- Submit your enrollment application through TMHP’s Provider Enrollment and Management System (PEMS) using the professional, not institutional, forms. Plan on up to 30 days for processing (how to apply).
- Complete a TMHP on-site visit if you attest to a designated office location — not required if you deliver services exclusively in client homes or other client-directed locations.
- Once TMHP fee-for-service enrollment is approved, separately contract and credential with each Medicaid managed care organization (MCO) you want to be in-network with (HHSC managed care service areas).
How Texas Delivers ABA
Texas runs a hybrid model: fee-for-service enrollment through TMHP, plus separate contracting with managed care organizations. MCOs operating in Texas Medicaid include Aetna Better Health, Amerigroup/Wellpoint, Blue Cross Blue Shield of Texas, Superior HealthPlan, Community First Health Plans, Cook Children’s Health Plan, Driscoll Children’s Health Plan, Texas Children’s Health Plan, and UnitedHealthcare Community Plan. In practice, FFS enrollment gets you started, but the rate you actually collect depends on which MCOs you credential with — each one negotiates and pays separately, so TMHP enrollment alone doesn’t guarantee access to a plan’s members.
Billing Notes
Prior authorization is required for ABA evaluation and treatment, submitted through the Comprehensive Care Program (CCP) Prior Authorization Request Form. An initial treatment plan is authorized for up to 180 days and needs the prescribing provider’s signature. A 90-day extension is available, and as of April 1, 2025, that extension no longer requires the prescribing provider’s signature. MCOs can layer their own additional prior-auth steps on top of the FFS process.
Telehealth is conditionally allowed. An LBA can deliver ABA evaluation and treatment by synchronous audio-visual technology when they judge it clinically appropriate. Behavior Technicians and LaBAs cannot — their direct ABA treatment has to happen in person.
One billing detail worth building into your workflow: the enrolled LBA, never the practice entity, must appear as both the rendering and billing provider on every claim, using their individual NPI. Claims billed under a group or employer NPI get rejected. Since BTs and LaBAs can’t enroll or bill independently, the LBA applies a modifier on each claim to show who delivered the service.
Common Questions
What does Texas Medicaid pay for CPT 97153?
Texas Medicaid pays $14.50 per 15 minutes for 97153 (direct treatment by a technician). That is about $58.00 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 Texas 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: Oklahoma · Louisiana · New Mexico · Arkansas