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Applied Behavior Analysis (ABA) therapy remains one of the most effective evidence-based treatments for individuals diagnosed with Autism Spectrum Disorder (ASD). For ABA providers across Maryland, understanding the Maryland Medicaid ABA Fee Schedule 2026 is essential for maximizing reimbursements, maintaining compliance, and ensuring sustainable practice growth.
In 2026, Maryland Medicaid continues to support ABA therapy services through approved providers and managed care organizations. Updated reimbursement rates, billing requirements, and coding guidelines have made it more important than ever for providers to stay informed.
This guide covers everything ABA providers need to know about Maryland Medicaid ABA reimbursement rates, CPT codes, billing procedures, and revenue cycle management strategies.
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The Maryland Medicaid ABA Fee Schedule is the official reimbursement framework that determines how ABA providers are paid for services delivered to Medicaid beneficiaries. The schedule outlines:
Maryland’s ABA services are administered through Medicaid and Carelon Behavioral Health, ensuring access to medically necessary autism treatment services.
The 2026 ABA fee schedule directly impacts:
Providers who fail to follow updated fee schedules often experience:
Behavior Identification Assessment
Used for:
Adaptive Behavior Treatment by Protocol
Used for:
Adaptive Behavior Treatment with Protocol Modification
Used when:
Family Adaptive Behavior Treatment Guidance
Used for:
These remain the most frequently billed ABA service codes in Maryland Medicaid.
Current FY 2026 reimbursement information indicates the following approximate rates:
| CPT Code | Service Description | Estimated Rate |
|---|---|---|
| 97151 | Behavior Assessment | $38.34 per unit |
| 97153 (BCBA) | Direct ABA Therapy | $24.41 per 15 min |
| 97153 (BCaBA) | Direct ABA Therapy | $20.91 per 15 min |
| 97153 (RBT) | Direct ABA Therapy | $19.17 per 15 min |
| 97155 | Protocol Modification | $38.34 per 15 min |
| 97156 | Parent Training | $20.91 per 15 min |
Actual reimbursement may vary based on provider credentials, modifiers, and payer-specific requirements.
To receive reimbursement from Maryland Medicaid, providers should:
Documentation should include:
Before rendering services:
Claims should include:
Many ABA providers lose revenue due to preventable billing mistakes.
Implementing strong revenue cycle management can significantly reduce denial rates.
Expired authorizations are a leading cause of claim denials.
Many providers receive incorrect reimbursements and never appeal them.
Professional ABA billing companies help:
Ensure all providers remain enrolled with Maryland Medicaid and managed care organizations.
Successful ABA organizations focus on:
Verify benefits before every treatment cycle.
Review claims prior to submission.
Aggressively follow up on:
Track:
Maryland continues to expand autism treatment access while emphasizing accountability and quality outcomes. ABA providers should expect:
Practices that invest in compliance, credentialing, and professional billing support will remain positioned for long-term growth.
The Maryland Medicaid ABA Fee Schedule 2026 provides important reimbursement guidance for ABA therapy providers serving children and families with autism. Understanding CPT codes, reimbursement rates, authorization requirements, and billing regulations is critical for maintaining healthy cash flow and maximizing revenue.
By implementing effective billing strategies, monitoring claims closely, and partnering with experienced ABA billing specialists, providers can reduce denials, improve collections, and focus on delivering exceptional patient care.
CPT 97153 is the most frequently used code for direct ABA therapy services.
Yes. Maryland Medicaid covers medically necessary ABA therapy services for eligible beneficiaries with Autism Spectrum Disorder.
Carelon Behavioral Health administers ABA-related behavioral health services and fee schedules for Maryland Medicaid.
Fee schedules are typically reviewed annually, although updates may occur throughout the year.
Common reasons include authorization issues, incorrect coding, missing documentation, and credentialing problems.
Many ABA practices outsource billing to improve collections, reduce denials, and ensure Medicaid compliance.
