Wisconsin Medicaid ABA Reimbursement Rates (2026)
From official Wisconsin Medicaid sources. Updated July 2026.
These are the published Wisconsin 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.
Wisconsin ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97151 | Behavior identification assessment (flat rate, all specialties; billed with TG or TF) Verified live on ForwardHealth interactive Max Fee search 2026-07-10; unchanged since the 8.7% behavioral-treatment increase effective 2/1/2023 (Update 2023-03). | $25.90 | per 15 min | 2023-02-01 | source |
| 97152 | Behavior identification supporting assessment by technician (flat rate; billed with TG or TF) Verified live 2026-07-10; limited to two assessments per handbook. | $22.93 | per 15 min | 2023-02-01 | source |
| 97153 (TF) | Adaptive behavior treatment by protocol — focused level (TF), Behavioral/Focused Treatment Licensed Supervisor (specialty 34/400, 34/403) Stored description said ‘BCBA telehealth’ — wrong. TF = focused level of service; $41.44 applies only when rendered by the licensed-supervisor specialties. Verified live 2026-07-10. | $41.44 | per 15 min | 2023-02-01 | source |
| 97153 (TF 52) | Adaptive behavior treatment by protocol — focused level rendered by Behavioral Treatment Technician (TF + 52, specialty 34/402) WI requires TF+52 when technicians render focused treatment. Same rate as TG. | $11.91 | per 15 min | 2023-02-01 | source |
| 97153 (TG) | Adaptive behavior treatment by protocol — comprehensive level of service (TG, any specialty) Stored row had blank modifier; the $11.91 pricing row carries modifier TG (comprehensive). Same $11.91 also applies to focused treatment rendered by technicians billed TF+52. WI modifiers denote treatment level, not credential. | $11.91 | per 15 min | 2023-02-01 | source |
| 97154 | Group adaptive behavior treatment by protocol — Licensed Supervisor tier (specialty 34/400, 34/403); per member Verified live 2026-07-10. Billed with TG or TF. | $12.71 | per 15 min | 2022-12-01 | source |
| 97155 | Adaptive behavior treatment w/ protocol modification (flat rate; licensed supervisor or therapist; billed with TG or TF) Verified live 2026-07-10. | $22.93 | per 15 min | 2023-02-01 | source |
| 97156 | Family adaptive behavior treatment guidance (flat rate; billed with TG or TF; add AM for team meetings) Verified live 2026-07-10. | $28.03 | per 15 min | 2023-02-01 | source |
| 97158 | Group adaptive behavior treatment w/ protocol modification — Licensed Supervisor tier (specialty 34/400, 34/403); per member Rate value verified current 2026-07-10; stored desc said ‘(BCBA)’ — corrected to WI’s licensed-supervisor specialty tier. Coverage began 12/1/2022 (Update 2022-54); group = 2-8 members, priced per member per 15 min. | $12.71 | per 15 min | 2022-12-01 | source |
How Wisconsin Compares
| Code | Wisconsin | National median | Difference |
|---|---|---|---|
| 97151 | $25.90 | $29.14 | 11% below national median |
| 97153 (TF) | $41.44 | $15.00 | 176% above national median |
| 97155 | $22.93 | $24.18 | 5% below national median |
| 97156 | $28.03 | $22.50 | 25% above national median |
Market Context
About 538,125 children in Wisconsin are enrolled in Medicaid. Autism prevalence is 3.8% (2022 data). ProviderSpark lists 55 verified ABA provider locations in Wisconsin.
Getting Paneled with Wisconsin Medicaid (BadgerCare Plus / ForwardHealth)
Wisconsin Medicaid pays for ABA under a benefit it calls the “Behavioral Treatment Benefit,” in place since January 1, 2016, and run through the ForwardHealth portal. Enrollment depends on which role you’re enrolling as:
- Pick the right provider specialty before you apply. A Behavioral Treatment Licensed Supervisor can bill and render; a Behavioral Treatment Therapist or Technician is rendering-only. Review the enrollment criteria for each specialty first.
- Complete the provider enrollment application on the ForwardHealth Portal, including the ownership/disclosure information required under ACA screening rules.
- Submit your credential documentation — BACB certification for supervisors and BCBAs, or an RBT certificate (or HS diploma/GED plus 40 hours of documented training) for technicians — and identify your supervising Licensed Supervisor’s NPI.
- Wait for ForwardHealth to confirm enrollment and assign your provider number/NPI linkage, then keep your licensure and demographic info current.
- Before you bill anything, get prior authorization from ForwardHealth for the member’s behavioral treatment.
How Wisconsin Delivers ABA
Wisconsin Medicaid pays for ABA fee-for-service, not through managed care plans. Even though most BadgerCare Plus members are enrolled in an HMO for their general care, behavioral treatment is one of the services specifically carved out of HMO managed care statewide. In practice, that means your ABA claims go straight to ForwardHealth, not to whatever HMO the member happens to be enrolled in — one billing relationship to manage instead of negotiating rates across multiple MCOs.
Billing Notes
Prior authorization is required before you bill. The member needs to be eligible (enrolled in BadgerCare Plus, Medicaid, or Katie Beckett with a diagnosed need for behavioral treatment), and the provider must get PA from ForwardHealth approving the treatment as medically necessary.
Telehealth is covered. Wisconsin’s Medicaid telehealth expansion includes behavioral health services, billed with modifier FQ for audio-only service or FR when the supervising practitioner is present via real-time two-way audio/video.
The billing quirk to know: because behavioral treatment is carved out of BadgerCare Plus HMO managed care, you bill ForwardHealth directly regardless of which HMO a member is enrolled in for their other care.
Common Questions
What does Wisconsin Medicaid pay for CPT 97153?
See the rate table above for the codes Wisconsin publishes.
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 Wisconsin 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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