At a glance:
- Effective March 1, 2026: ABA service reimbursement will be based on weekly approved units instead of total authorized units.
- Action required: Review authorizations, update billing systems, and educate staff to align with the new weekly structure and prevent claim delays.
New weekly structure for ABA service reimbursement starts in 2026
Effective March 1, 2026, reimbursement for Applied Behavioral Analysis (ABA) services will be based on weekly approved units rather than total authorized units.
This change helps streamline claim processing, ensure consistency in service delivery, and reduce administrative adjustments. No action is required for existing requests and claims, including those submitted before the effective date and those with date ranges that extend beyond it.
Supporting access to ABA care for members
Transitioning to a weekly unit structure helps members access care reliably by promoting timely, appropriate ABA services and reducing service disruptions caused by administrative delays.
How this change affects your billing and claims submissions
We encourage care providers to familiarize themselves with these changes to ensure compliance and continuity of care.
Claims should reflect the units rendered within each week, up to the weekly medically necessary limit as approved by prior approval. Claims submitted with units exceeding the weekly limit will be considered ineligible for reimbursement and will be adjusted accordingly.
Steps to prepare your practice and prevent claim delays
To ensure a smooth transition and avoid claim issues or payment delays:
- Review your upcoming authorizations to identify the weekly approved units.
- Update your internal billing systems and scheduling processes to align with the new weekly authorization structure.
- Educate staff responsible for claims submissions to ensure they are informed and prepared to implement this change.
Affected CPT® codes
Code | Unit | Description |
97151 | per 15 min | Behavior identification assessment by a qualified health professional, including the assessment of the development of the treatment plan, each 15 minutes |
97152 | per 15 min | Behavior identification supporting assessment by one technician under the direction of a qualified health professional, each 15 minutes |
0362T | per 15 min | Observation and assessment of the patient’s behavior and environment by a qualified health professional, with particular emphasis on supervision by a physician, each 15 minutes |
97153 | per 15 min | Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified healthcare professional, face-to-face with one patient, each 15 minutes |
97154 | per 15 min | Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified healthcare professional, face-to-face with two or more patients, each 15 minutes |
97155 | per 15 min | Adaptive behavior treatment with protocol modification, administered by physician or other qualified healthcare professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes |
97156 | per 15 min | Family adaptive behavior treatment guidance, administered by physician or other qualified healthcare professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes |
97157 | per 15 min | Multiple-family group adaptive behavior treatment guidance, administered by physician or other qualified healthcare professional (without the patient present), face-to-face with multiple sets of guardians/caregivers, each 15 minutes |
97158 | per 15 min | Group adaptive behavior treatment with protocol modification, administered by physician or other qualified healthcare professional face-to-face with multiple patients each 15 minutes (code is used when the youth also has an assigned one-on-one technician present during the group treatment) |
0373T | per 15 min | Adaptive behavior treatment with protocol modification, each 15 minutes of technicians’ time face-to face with a patient, requiring the following components:
Completed in an environment that is customized to the patient’s behavior |
