Washington Medicaid ABA Reimbursement Rates (2026)
From official Washington Medicaid sources. Updated July 2026.
These are the published Washington 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.
Washington ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 0362T | Behavior identification supporting assessment (LBAT on-site + 2 or more CBTs, destructive behavior) Limit 2-hour assessments, 3/calendar year per client per provider. | $58.80 | per 15 min | 2026-01-01 | source |
| 0373T | Adaptive behavior treatment with protocol modification, customized environment (LBAT on-site + 2 or more CBTs) Was $24.60 in 2024. PA required; do not bill with 97155 or 97153. | $24.11 | per 15 min | 2026-01-01 | source |
| 97151 | Behavior identification assessment (LBAT only) Was $19.17 (eff 2024-01-01); reduced eff 2026-01-01, unchanged in the current 2026-07-01 schedule. Limit 28 units per assessment, 2 assessments/year. | $18.79 | per 15 min | 2026-01-01 | source |
| 97153 | Adaptive behavior treatment by protocol (CBT/technician) Was $12.65 (eff 2024-01-01); reduced eff 2026-01-01. PA required. | $12.40 | per 15 min | 2026-01-01 | source |
| 97154 (UN) | Group adaptive behavior treatment by protocol, 2 clients (per-client rate) Priced per client. Larger groups pay less per client: UP(3)=$11.41, UQ(4)=$10.50, UR(5)=$9.66, US(6+)=$8.88. PA required. | $12.40 | per 15 min | 2026-01-01 | source |
| 97155 | Adaptive behavior treatment with protocol modification (requires LBAT involvement) Was $14.38 (eff 2024-01-01); reduced eff 2026-01-01. | $14.09 | per 15 min | 2026-01-01 | source |
| 97156 | Family adaptive behavior treatment guidance (LBAT required) Was $18.69 (eff 2024-01-01); reduced eff 2026-01-01. | $18.32 | per 15 min | 2026-01-01 | source |
| 97157 (UN) | Multiple-family group adaptive behavior treatment guidance, 2 caregivers (per-client rate, LBAT required) Per-client pricing; UP(3)=$9.52, UQ(4)=$8.74, UR(5)=$8.05, US(6+)=$7.41. | $10.34 | per 15 min | 2026-01-01 | source |
| 97158 (UN) | Group adaptive behavior treatment with protocol modification, 2 clients (per-client rate, LBAT involvement) Per-client pricing; UP(3)=$11.41, UQ(4)=$10.50, UR(5)=$9.66, US(6+)=$8.88. PA required. | $12.40 | per 15 min | 2026-01-01 | source |
How Washington Compares
| Code | Washington | National median | Difference |
|---|---|---|---|
| 97151 | $18.79 | $29.14 | 36% below national median |
| 97153 | $12.40 | $15.00 | 17% below national median |
| 97155 | $14.09 | $24.18 | 42% below national median |
| 97156 | $18.32 | $22.50 | 19% below national median |
Market Context
Washington has had an autism insurance mandate since 2007. About 821,362 children in Washington are enrolled in Medicaid. Autism prevalence is 4.3% (2022 data). ProviderSpark lists 126 verified ABA provider locations in Washington.
Getting Paneled with Washington Apple Health (Medicaid)
Washington’s Medicaid enrollment runs through two agencies before you can bill a claim: DOH for your license, then the Health Care Authority (HCA) for provider enrollment. The steps, in order:
- Get your DOH credential first: LBA, LABA, or CBT, depending on your role. DOH ABA licensing
- If you’re billing as an analyst or supervisor, enroll with HCA as a Lead Behavior Analysis Therapist (LBAT): an unrestricted DOH license in good standing, or a licensed mental health counselor, MFT, social worker, or psychologist with a signed ABA Attestation form (HCA 13-0008) confirming BCBA/BCaBA status. See the ABA Program Billing Guide.
- Sign a Core Provider Agreement (CPA) with HCA and enroll as a service provider under Chapter 182-502 WAC. LBATs also need supervision authorization; CBTs sign a CPA too, with no supervision authorization required. Enroll as an Apple Health provider
- Complete enrollment in ProviderOne, the state’s Medicaid management system, using HCA’s enrollment manuals. Learn ProviderOne
- To be recognized as a Center of Excellence (COE) evaluator, submit a signed COE Attestation form (HCA 13-0009) to ABA@hca.wa.gov.
How Washington Delivers ABA
Washington Apple Health runs ABA as a hybrid model: some claims go through fee-for-service (FFS), others through managed care organizations (MCOs), Coordinated Care of Washington, Community Health Plan of Washington, Molina Healthcare of Washington, UnitedHealthcare Community Plan of Washington, and Wellpoint Washington (formerly Amerigroup). Your rate and prior-auth process depend on whether a client is FFS or assigned to one of those five plans, since each MCO sets its own PA rules. Plan on a separate credentialing conversation with each MCO you want to bill, not just one state-level enrollment.
Billing Notes
Prior authorization is required for FFS clients, submitted at least 15 days before services start or the current authorization expires; MCO clients follow that plan’s own PA rules. PA is also required whenever a client has exhausted private ABA benefits, has private insurance with no ABA benefit, or has Medicare. The initial request needs the COE’s diagnostic evaluation and treatment plan, the LBAT’s ABA assessment, and a completed Level of Support Requirement form (HCA 12-411). Authorizations run 3-6 months; recertification means the LBAT submits a new request at least three weeks out, with an updated Level of Support form and progress documentation.
Telehealth is limited: direct, technician-delivered ABA (CPT 97153, 97154, 97158) and direct assessments (0362T, 0373T) must happen in person in a clinic, not by telemedicine. Supervisory, caregiver-training, and team-conference codes (99366, 99368, 97155, 97156, 97157) are unrestricted, and indirect work like treatment-plan development, record review, and scoring is telemedicine-eligible. One quirk: additional units mid-authorization get a separate request faxed with the PA Pend Form as the cover sheet, not a new PA submission, a point the billing guide flags as commonly confused.
Common Questions
What does Washington Medicaid pay for CPT 97153?
Washington Medicaid pays $12.40 per 15 minutes for 97153 (direct treatment by a technician). That is about $49.60 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 Washington 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: Oregon · Idaho