Florida Medicaid Applied Behavior Analysis Fee Schedule Rates 2026

Applied Behavior Analysis (ABA) Fee Schedule Rates for Florida Medicaid in 2026

The Behavior Analysis Fee Schedule is much more than a collection of codes and payment rates. For Applied Behavior Analysis (ABA) providers, the Fee Schedule serves as the operational guide for how services are provided, billed, and reimbursed.

The 2026 Florida Medicaid reimbursement rate for Applied Behavior Analysis (ABA) is based on a standardized CPT code system. Each service provided by ABA providers includes:

• a specific procedure CPT code selection
• a modifier
• a payment amount for every 15 minutes billed
• a series of restrictions defining when and how each service may be billed

Here’s a quick overview of Applied Behavior Analysis Fee Schedule for Florida Medicaid:

Service Description	CPT Code	Modifier	Rate ($/15 min)	Notes
Behavior treatment by protocol	97153	—	$12.26	RBT, BCaBA, or Lead Analyst
Behavior treatment by protocol (concurrent)	97153	XP	Not reimbursable	Only supervisor is paid
Protocol modification (Lead Analyst)	97155	—	$19.17	Real-time protocol changes
Protocol modification (BCaBA)	97155	HN	$15.37	Assistant behavior analyst
ProtocolModification (ConcurrentSupervision)	97155	XP	Not reimbursed	Supervisor may be reimbursed using97155 or 97155HN
Family training (in-person)	97156	—	$19.05	Provided by a Lead Analyst
Family training (BCaBA)	97156	HN	$15.24	Provided by BCaBA
Family training (telemedicine)	97156	GT	$19.05	Max 2 hrs/week
Group treatment (2 clients)	97154	UN	$7.58	Max 6 clients
Group treatment (3 clients)	97154	UP	$7.08	Max. 6 clients
Group treatment (4 clients)	97154	UQ	$6.58	Max. 6 clients
Group treatment (5 clients)	97154	UR	$6.08	Max. 6 clients
Group treatment (6 clients)	97154	US	$5.58	Max. 6 clients
Group protocol modification (2 clients)	97158	UN	$9.58	Lead/BCaBA only
Group protocol modification (3 clients)	97158	UP	$9.08	Lead/BCaBA only
Group protocol modification (4 clients)	97158	UQ	$8.58	Lead/BCaBA only
Group protocol modification (5 clients)	97158	UR	$8.08	Lead/BCaBA only
Group protocol modification (6 clients)	97158	US	$7.58	Lead/BCaBA only

Behavior Identification and Assessment Fee Schedule

The purpose of these services is to ensure an appropriate assessment before providing treatment. Each CPT code establishes both the limits in terms of:

• the number of units that can be billed (per session)
• the reimbursement rates for each service provided 
• the scope of what will be reimbursed under a particular CPT code.

The table below shows reimbursement and service limitations for Behavior Identification and Assessment services in 2026.

Service Description	CPT Code	Modifier	Reimbursement	Service Limitations
Behavior identification  assessment	97151	—	$19.05 per 15 min	Maximum 24 units per behavior assessment
Behavior identification  supporting assessment	97152	—	$12.19 per 15 min	Maximum 8 units per behavior assessment
Assessment add-on practitioner	0362T	—	$12.19 per 15 min	Maximum 16 units; must be prior authorized and medically necessary
Behavior reassessment	97151	TS	$19.05 per 15 min	Maximum 18 units per reassessment

Assessment Process – CPT Code 97151

When starting with a new client, the provider must conduct an assessment. An assessment is defined by CPT code 97151. Florida Medicaid has established a maximum amount of 24 units to pay providers for each behavioral assessment.

Remember that payment is made for every fifteen minutes of the assessment process. So, twenty-four units equates to six hours of time for the assessment. This amount of time is usually sufficient to complete a thorough initial evaluation.

The reimbursement rate for this service is $19.05 per unit (per fifteen minutes).

This is one of the highest amounts paid under the 2026 fee schedule for Florida Medicaid. This reflects the importance of conducting an accurate assessment before developing a treatment plan.

Additional Support During the Assessment Process – CPT Code 97152

There may be times when a secondary assessor requires assistance during the assessment process. For example, another observation may be required, or additional data may need to be collected. In such situations, the provider could bill for CPT code 97152.

CPT 97152 is used to support the original assessor and provides additional reimbursement for services related to assessing the patient’s  behavior. 

The reimbursement rate for 97152 is $12.19 per unit (fifteen-minute intervals). However, Florida Medicaid limits the number of units (supporting assessment) to eight units per behavior assessment. 

To put this into perspective, 97152 represents the “support” role for the primary assessment.

Adding Time to Assessments – CPT Code 0362T

As a provider, if you want to conduct an in-depth assessment of their client, use the CPT code 0362T (additional assessment time). This specific code allows you to provide additional time to assess the client. 

However, you must follow these parameters: 

• you can only bill up to sixteen units for either an initial behavior assessment or reassessment
• the service must also be prior authorized and deemed medically necessary 

If you fail to obtain prior authorization and/or if the service does not meet medical necessity requirements, you will not receive any reimbursement. The reimbursement rate for 0362T is $12.19 per unit (every fifteen minutes).

Re-Assessments – CPT Code 97151 TS

Your patients won’t stay in the same place forever. They are always making progress and hitting new milestones. So, their behavioral plans require updates periodically, which will necessitate periodic re-assessments. 

A re-assessment uses the same base code as an initial assessment:97151. However, it includes the TS modifier so that a distinction exists between a re-assessment versus a new assessment. Florida Medicaid will reimburse a maximum of eighteen units for a re-assessment. The reimbursement rate remains at $19.05 per unit (every fifteen minutes).

ABA Therapy Treatment Services Fee

When providing services under a Florida Medicaid ABA Billing program, providers generally bill using two main service code categories:

• The first category (97155) allows clinicians to bill for “protocol modification” when they are making active changes to the patient’s treatment plan on an as-needed basis.
• The second category (97153) allows clinicians to bill for delivering services based upon a previously developed treatment plan.

That distinction affects both billing logic and reimbursement, with 97153 paid at $12.26 per 15 minutes and 97155 paid at $19.17, or $15.37 with the HN modifier for BCaBA services.

Service	CPT Code	Modifier	Rate ($/15 min)	Providers	Notes
Behavior Treatment by Protocol	97153	—	$12.26	RBT, BCaBA, Lead Analyst	Direct, hands-on ABA therapy
Concurrent Supervision	97153	XP	Not reimbursable	—	Only supervisor services are billable unless prior authorized

Behavior Treatment by Protocol – CPT Code 97153

A large part of ABA therapy involves treatment services. The most commonly used code for ABA treatment is CPT 97153 (Behavior Treatment by Protocol).

CPT 97153 provides coverage for behavioral treatment by protocol: the direct, hands-on therapy performed by Registered Behavior Technicians, Bachelor’s-level Assistant Behavior Analysts, and Lead Analysts.

The 2026 reimbursement rate for each unit of CPT 97153 is $12.26 per 15 minute unit.

Concurrent Supervision Rule (97153 XP)

There is an exception to this rule: when two behavior analysts provide services to the same client at the same time. In this situation, the payer will reimburse only one provider’s services. Concurrent services are covered only if they were preauthorized and documented as medically necessary in the approved behavior plan.

This is referred to as the “Concurrent Supervision Rule,” and many behavioral health practices struggle with it. Additionally, CPT 97153 has an XP (concurrent) modifier. Some providers think that using this modifier will allow them to bill for the technician’s time alongside the supervisor’s. However, this is not true.

In Florida, the XP modifier identifies the technician’s service as non-reimbursable during that window. Only the supervisor’s services are billable, typically through CPT 97155 for a Board Certified Behavior Analyst (BCBA) or CPT 97155-HN for a Board Certified Assistant Behavior Analyst (BCaBA), based on their level of certification.

Reimbursement Rates for Behavior Treatment with Protocol Modification (97155)

Service	CPT Code	Modifier	Rate ($/15 min)	Notes
Protocol Modification (Lead Analyst)	97155	—	$19.17	Used when making real-time treatment adjustments
Protocol Modification (BCaBA)	97155	HN	$15.37	Assistant behavior analyst services
Protocol Modification (Concurrent Supervision)	97155	XP	Not reimbursed	Supervisor may be reimbursed using97155 or 97155HN

Protocol Modification (97155)

CPT code 97155 stands for Behavior Treatment with Protocol Modification. It ensures reimbursement for the services of a lead analyst who modifies the treatment protocol during the delivery of the treatment.

Simply put, if a lead analyst is doing more than just delivering the treatment, but also making adjustments to the clinical approach in real-time; those services should be billed as CPT 97155.

Reimbursement rates for CPT 97155 for lead analysts are $19.17 per 15 minute units.

Protocol Modification – BCaBA (97155 HN)

For Board Certified Assistant Behavior Analyst (BCaBA) providers who offer these services, the HN modifier must be applied. This helps them receive accurate reimbursement at the appropriate professional rate.

Reimbursement rates for these services will be $15.37 per 15 minute units.

Medicaid Fee Schedule for ABA Family Training

Family training is an important component of the billable services that are included in ABA service reimbursement. As of January 1, 2026 Florida Medicaid’s fee schedule includes CPT 97156 as “family/caregiver focused training”, which will be reimbursed at $19.05 per 15 minutes for the Lead Analyst, $15.24 when billed with the HN modifier for the Board Certified Assistant Behavior Analyst (BCaBA), and $19.05 when billed with the GT modifier for Telehealth. The total amount billed may not exceed the stated weekly limit for the service provided.

Service	CPT Code	Modifier	Rate ($/15 min)	Notes / Limits
Family Training (In-person Lead Analyst)	97156	—	$19.05	Provided by a Lead Analyst
Family Training (BCaBA)	97156	HN	$15.24	Provided by BCaBA
Family Training (Telemedicine)	97156	GT	$19.05	Max 2 hours per week

In Person Family Training – CPT Code  97156

Lead Analysts are eligible to bill 97156 at a rate of $19.05/15 min for family training delivered in person. The 2026 Fee Schedule does not specify a unit cap for in-person family training. Therefore, there is potential for additional billing units for practices providing more intense coaching to families.

BCaBAs may also be able to deliver family training (billable under 97156 HN at a rate of $15.24/15 min).

Family Training via Telemedicine – CPT Code 97156 GT

Telemedicine within the ABA field has seen tremendous growth in the last few years. And it will continue to grow. Using the GT Modifier on 97156 identifies family training delivered via telemedicine. As mentioned in the table above, Florida Medicaid limits this service to a maximum of 2 hours per week.

Telemedicine rates for family training are the same as in-person rates. A lead analyst receives $19.05 per 15 minutes when providing family training remotely. This provides a practical option for families living in remote locations or where travel limitations exist.

Florida Medicaid Group ABA Rates

Billing for Group ABA Services is more complex than individual medical billing in Florida, yet it is a vital part of many programs. Florida Medicaid includes these in the 2026 Fee Schedule under CPT 97154 (Treatment by Protocol) and CPT 97158 (Group Protocol Modification).

While these codes are nationally defined for up to 8 patients, Florida Medicaid limits group sizes to 2–6 patients per provider. You must use specific provider modifiers to identify the level of the professional leading the session to ensure correct reimbursement.

The table below lists the modifiers and corresponding rates for each code:

Service Description	CPT Code	Provider Modifier	Rate (Per 15 Min)	Group Size Limit
Group Treatment by Protocol	97154	— (BCBA/Lead)	$5.12	2–6 Patients
Group Treatment by Protocol	97154	HN (BCaBA)	$4.10	2–6 Patients
Group Treatment by Protocol	97154	HM (RBT)	$3.28	2–6 Patients
Group Protocol Modification	97158	— (BCBA/Lead)	$9.58	2–6 Patients
Group Protocol Modification	97158	HN (BCaBA)	$7.66	2–6 Patients

Group Behavior Treatment by Protocol – CPT 97154

For group services, Florida Medicaid uses a flat-rate reimbursement model rather than a sliding scale. This ensures that the clinical quality remains the primary focus, regardless of how many participants are in the group.

Under the 2026 Fee Schedule, the following rates apply for each 15-minute unit per child:

Provider Level	Modifier	Rate ($/15 Minutes)	Group Size Limit
Lead Analyst (BCBA)	—	$5.12	2–6 Patients
Assistant Analyst (BCaBA)	HN	$4.10	2–6 Patients
Technician (RBT)	HM	$3.28	2–6 Patients

Florida Medicaid’s Fee Schedule for CPT 97158 (Group Behavior Treatment with Protocol Modification)

While standard group sessions focus on following a plan, CPT 97158 is a higher-level service used when an analyst is actively modifying treatment protocols in a group setting. Because this requires advanced clinical judgment, it is reimbursed at a higher rate than standard group therapy.

In Florida, this code is billed at a flat rate per child, regardless of whether there are 2 or 6 participants in the session.

Provider Level	Modifier	Rate ($/15 Minutes)	Group Size Limit
Lead Analyst (BCBA)	—	$9.58	2–6 Patients
Assistant Analyst (BCaBA)	HN	$7.66	2–6 Patients

Things to remember for CPT 97158:

• This is a “Professional-Only” code. Only BCBAs and BCaBAs can bill for 97158. Because it involves modifying a protocol. On the other hand, RBTs (Technicians) cannot bill for this service.
• Florida Medicaid limits these groups to a maximum of six (6) clients per provider to ensure medical necessity and clinical quality.
• Florida does not use sliding-scale modifiers (like UN or UP). Each child in the group is billed as an individual claim at the full rate listed above.

Why is the rate higher? The reimbursement for 97158 is higher than 97154 ($9.58 vs $5.12) because it acknowledges the “higher level clinical skill” required to analyze data and change protocols for multiple children at once.

Florida Medicaid Prior Authorization Rules for ABA Add-On Codes

You will notice throughout the 2026 Medicaid Behavior Analysis Fee Schedule, Florida, where it states “the need must be prior authorized and determined to be medically necessary.” This is not just jargon; it is an important billing requirement.

The two billing items to bring your attention are 0362T (assessments add-ons) and 0373T (treatment add-ons). There is no negotiation possible with regard to prior authorization.

If these claims are submitted without prior authorization, they will be denied. To ensure timely reimbursement of both assessments and treatments add-ons use the following checklist to review each claim:

• Is the service listed as “requires prior authorization”?
• Was the prior authorization completed before the service was provided; or, did the provider wait until after the service was provided to submit the claim?
• Are all the details for the medical necessity of the client included in their Behavior Plan?
• Is the prior authorization shown in the approved behavior plan on file?

In many cases, taking time to do things correctly from the beginning ensures less effort and time taken to accomplish accurate processing. There is less frustration at the backend with respect to administrative issues.

Florida Medicaid Rules for Concurrent Supervision in ABA Therapy

Concurrent supervision is often a source of confusion within the Florida Medicaid framework. However, the rule is actually quite straightforward. Concurrent billing occurs when a supervising practitioner (BCBA or BCaBA) and an assistant (RBT) work with the same client at the exact same time.

The most important thing to know is that in Florida, both the supervisor and the technician can typically be reimbursed for their time during these overlapping sessions. This is because they are providing two distinct services: 

1. the technician provides the direct therapy
2. while the supervisor provides the high-level protocol modification.

How Concurrent Supervision Works in Practice:

The Lead Analyst (BCBA) bills for services using 97155. They are there to modify the protocol and direct the session.

• The Assistant Analyst (BCaBA) bills for services using 97155 with the HN modifier.
• The Technician (RBT) continues to bill for their direct therapy using 97153 (often with the HM modifier).

Unlike some other medical fields, ABA is unique because the presence of a supervisor doesn’t “cancel out” the technician’s work. Both roles are medically necessary and billable simultaneously.

Best Practices for Filing Clean ABA Claims in Florida Medicaid

Filing a “clean” claim means getting your reimbursement right the first time without the headache of denials or “rework.” To keep your revenue flowing in 2026, follow these Florida-specific best practices:

1). Match Modifiers to the Right Professional

A single modifier error is the main reason claims get denied and sent back. In Florida, ensure your billing methodology is set according to these specific codes:

• No Modifier: Reserved for the Lead Analyst (BCBA).
• HN Modifier: Use this for the Assistant Analyst (BCaBA).
• HM Modifier: Use this for the Technician (RBT).
• Modifier 95: This is now the standard for Telehealth (such as Parent Training – 97156) instead of the older GT modifier.

2). Respect the Unit “Soft Caps” 

While every child’s needs are unique, Florida Medicaid typically has standard unit limits for assessments. Exceeding these without specific prior authorization (PA) will lead to an automatic denial.

• Initial Assessment (97151): Usually capped at 32 units (8 hours).
• Re-assessment (97151): Typically capped at 24 units (6 hours).
• Supporting Assessment (97152): Often limited to 8–16 units depending on the complexity authorized in your plan.
• Always verify your specific Managed Care Plan (Molina, Sunshine, etc.) portal, as they may have slightly different internal thresholds.

3). Documentation is Your Best Defense 

Document medical necessity as if your reimbursement depends on it. Only this way, you can ensure timely and complete reports. 

4). Concurrent Services

Your notes must clearly show the supervisor was providing “Clinical Direction” or “Protocol Modification” while the technician was implementing the plan.

5). Add-on Codes

For high-intensity codes (0362T/0373T), your notes serve as the evidence that the patient’s behavior was severe enough to require extra staffing.

Simple Tracking for Telehealth Develop an internal system to track 97156 (Family Training) usage. In 2026, many plans limit telehealth parent training to 2 hours per week. As this limit is easy to accidentally cross, a weekly “check-in” on your units can prevent unpaid claims.

6). Forget the “Sliding Scale” for Groups 

You may see modifiers like UN or UP in other medical manuals. However, you must not use them for ABA. In Florida, you bill a flat rate per child. If a group of four drops to three because of a “no-show,” you don’t change your modifier. You will simply bill for the three children who were present.