West Virginia Medicaid ABA Reimbursement Rates (2026)
From official West Virginia Medicaid sources. Updated July 2026.
These are the published West Virginia 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.
West Virginia ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97151 | Behavior identification assessment | $29.14 | per 15 min | 2020-04-01 | source |
| 97153 | Adaptive behavior treatment by protocol | $9.90 | per 15 min | 2021-04-01 | source |
| 97155 | Adaptive behavior treatment w/ protocol modification | $29.14 | per 15 min | 2020-04-01 | source |
| 97156 | Family adaptive behavior treatment guidance | $17.43 | per 15 min | 2020-04-01 | source |
How West Virginia Compares
| Code | West Virginia | National median | Difference |
|---|---|---|---|
| 97151 | $29.14 | $29.14 | 0% above national median |
| 97153 | $9.90 | $15.00 | 34% below national median |
| 97155 | $29.14 | $24.18 | 21% above national median |
| 97156 | $17.43 | $22.50 | 23% below national median |
Market Context
About 197,772 children in West Virginia are enrolled in Medicaid. Autism prevalence is 3.4% (2022 data). ProviderSpark lists 16 verified ABA provider locations in West Virginia.
Getting Paneled with West Virginia Medicaid, administered by the Bureau for Medical Services (BMS); the managed-care arm is branded “Mountain Health Trust” (and “Mountain Health Promise” for the foster-care/CPS-involved population, served by a single MCO)
Enrollment runs through the state’s fiscal agent, not BMS directly. Here’s the sequence:
- Confirm your BCBA/BCaBA/RBT certification, NPI, W-9, and liability info against the general provider participation requirements in BMS Provider Manual Chapter 300.
- Create an account and complete the Provider Enrollment Application online.
- Submit the application and required attachments through the Health PAS-OnLine provider enrollment portal.
- Track status or resolve issues with the Provider Enrollment Unit at (888) 483-0793, detailed on the enrollment and revalidation FAQ.
- To see Mountain Health Trust members, separately credential and contract with each MCO you want to bill, listed on the Mountain Health Trust page.
How West Virginia Delivers ABA
West Virginia runs a hybrid model: fee-for-service Medicaid alongside four MCOs — Aetna Better Health of West Virginia, The Health Plan of West Virginia, Highmark Health Options of West Virginia, and Wellpoint of West Virginia. Your actual reimbursement depends on which MCO a given family is enrolled with, not one statewide Medicaid rate. Paneling with BMS alone isn’t enough if most of your referrals carry an MCO card — you need each MCO contract in place to get paid for those members.
Billing Notes
Prior authorization is required for every ABA service before you deliver it, and West Virginia denies retrospective or back-dated PA requests outright — there’s no fixing a missed authorization after the fact. A PA request needs a qualifying ASD diagnostic assessment from before age 8 (within the last 24 months), a comprehensive diagnostic assessment from a qualifying provider (also within 24 months), an annual physician’s order, a signed consent-to-release or Statement of Assurances, and an annual functional assessment of adaptive skills. Individual CPT codes (97151-97156, 97158) each need their own PA and are capped, combined, at 40 hours a week and 8 hours in any 24-hour period. Telehealth is allowed, following the state’s general telehealth policy (519.17).
A few billing traps worth building into intake: if a PA is denied or never obtained, you cannot bill the family privately for that period. Services requested directly by a parent or guardian, outside the PA process, aren’t accepted. Only one staff person’s time can be billed for a given activity, so overlapping BCBA and RBT billing on the same task isn’t allowed. Phone calls, emails, and faxes with the member aren’t separately reimbursable. Group codes 97154 and 97158 are capped at eight members per group, and ABA can’t duplicate anything already covered by an IEP.
Common Questions
What does West Virginia Medicaid pay for CPT 97153?
West Virginia Medicaid pays $9.90 per 15 minutes for 97153 (direct treatment by a technician). That is about $39.60 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 West Virginia 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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