Maryland Medicaid ABA Fee Schedule 2026
The Maryland Department of Health (MDH) has a new Applied Behavior Analysis (ABA) fee schedule. It took effect on February 1, 2026, along with new rules.
This update affects almost everyone in your practice. Clinic owners plan around it. BCBAs with large caseloads feel it. So do billing specialists who are tired of chasing denied claims.
The 2026 schedule sets daily unit limits, modifier rules, and authorization rules. You need to know all three. There is no room for guesswork.
→First, here is the foundation every claim rests on:
- Maryland Medicaid covers ABA only when it is medically necessary.
- The child must be under the age of 21. They must also have a confirmed Autism Spectrum Disorder (ASD) diagnosis from a qualified health care professional (QHCP).
- On top of that, the service must fall under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.
- Maryland pays for ABA on a fee-for-service basis. The payer is its Behavioral Health Administrative Service Organization (BHASO), Carelon Behavioral Health (Carelon).
Before we get to the numbers, you need to know one major rule. It applies to all Maryland behavioral health providers.
Critical administrative information: As the BHASO, Carelon manages service authorizations for the Maryland Department of Health (MDH). So before you deliver or bill any ABA service, Carelon must review and approve it first.
What this means:
- No approval before the service usually means a denied claim.
- Approval confirms that the service is medically necessary and covered.
- To approve a service, Carelon usually wants treatment plans, assessments, and other documents.
- Each authorization lasts up to 180 days. You must reassess the client before it ends to keep services active.
No Carelon authorization means a high risk of nonpayment for the service.
Maryland Medicaid ABA Fee Schedule (Effective February 1, 2026)
Reimbursement is based on 15-minute units. Each rate depends on the provider's credential. Each service also has a daily cap on billable units.
| CPT Code | Description | Provider & Rate | Time | Daily Max | Limitations |
|---|---|---|---|---|---|
| 97151 | Behavior Identification Assessment, including treatment planning | Psychologist / BCBA-D / BCBA — $38.34 | 15 min | 32 units | None |
| 97152 | Behavior Identification Supporting Assessment | BCaBA / RBT / BT — $19.17 | 15 min | 32 units | None |
| 0362T | Exposure Behavior Identification Supporting Assessment | 2+ BCaBAs/RBTs/BTs with Psychologist/BCBA-D/BCBA on site — $52.28 | 15 min | 32 units | Psychologist / BCBA-D / BCBA must be on site, immediately available, and interruptible to provide assistance and direction |
| 97153 | Adaptive Behavior Treatment by Protocol | Psychologist / BCBA-D / BCBA — $24.41BCaBA — $20.91RBT / BT — $19.17 | 15 min | 32 units | None |
| 97154 | Group Adaptive Behavior Treatment by Protocol | Psychologist / BCBA-D / BCBA — $10.45 / participantBCaBA — $8.36 / participantRBT / BT — $6.96 / participant | 15 min | 16 units | Group limited to 2 to 8 participants |
| 97155 / 97155 (GT) | Adaptive Behavior Treatment by Protocol Modification / Direction | Psychologist / BCBA-D / BCBA — $38.34 | 15 min | 24 units | GT modifier signifies remote direction of a technician |
| 97156 | Family Adaptive Behavior Treatment Guidance, without the child present; may include care coordination | Psychologist / BCBA-D / BCBA — $20.91BCaBA — $12.21 | 15 min | 16 units | None |
| 97156 (U2) | Family Adaptive Behavior Treatment Guidance, with the child present | Psychologist / BCBA-D / BCBA — $38.34BCaBA — $20.91 | 15 min | 16 units | Use the U2 modifier |
| 97157 | Multiple-Family Group Adaptive Behavior Treatment Guidance | Psychologist / BCBA-D / BCBA — $12.91 per family | 15 min | 10 units | Group limited to 2 to 8 families |
| 97158 | Group Adaptive Behavior Treatment with Protocol Modification | Psychologist / BCBA-D / BCBA — $10.45 per participant | 15 min | 10 units | Group limited to 2 to 8 participants |
| 0373T | Exposure Adaptive Behavior Treatment with Protocol Modification | 2+ BCaBAs/RBTs/BTs with Psychologist/BCBA-D/BCBA on site — $52.28 | 15 min | 24 units | Psychologist / BCBA-D / BCBA must be on site, immediately available, and interruptible to provide assistance and direction |
What Are the CPT Codes, Rates, and Limits in the Maryland ABA Fee Schedule?
The Maryland ABA fee schedule covers four things for each service. It sets the reimbursement rate, the billing unit, the daily limit, and any service limits.
To make it easier to follow, we group the services into billing categories. These cover assessments, direct treatment, family and caregiver education, supervision and protocol modification, group services, and high-intensity behavior services.
Each category lists the CPT codes and who can bill them. It also shows the rates, billing units, daily limits, and any special rules.
Assessment Codes
Every course of treatment starts with an assessment. This phase establishes where the client is right now: their current skills, the behaviors getting in the way, and what a realistic treatment plan should target.
The codes below cover that groundwork — they're what pays for the clinical evaluation work behind every case.
→CPT 97151: Behavior Identification Assessment, Including Treatment Planning
Bill this code for a new client's full intake. A psychologist, BCBA-D, or BCBA evaluates the client, records behavior, interviews the family, and builds the formal behavior plan from that intake.
- Who can perform this service: Psychologist, BCBA-D, or BCBA
- Payment rate: $38.34 per 15-minute unit
- Daily unit limit: Up to 32 units (8 hours) per client, per day
→CPT 97152: Behavior Identification Supporting Assessment
Some assessments need an extra set of hands. Use 97152 when a technician or other staff member assists the lead clinician during that initial assessment, observing the client or helping gather data.
Important note: the technician or assistant cannot write the treatment plan. They only help collect data.
- Who can provide this support: BCaBA, RBT, or BT
- Payment rate: $19.17 per 15-minute unit
- Daily unit limit: Up to 32 units (8 hours) per client, per day
→CPT 0362T: Exposure Behavior Identification Supporting Assessment
0362T is for high-risk assessments — cases where the client's behavior could put them or others at risk, such as severe self-injury or violent aggression. It calls for at least two technicians or support staff working at once, with a licensed supervisor overseeing them.
The team for this service includes:
- At least two BCaBAs, RBTs, or BTs to assist
- A licensed psychologist, BCBA-D, or BCBA on site, ready to step in right away
- Payment rate: $52.28 per 15-minute unit
- Daily unit limit: Up to 32 units (8 hours) per client, per day
- Special requirement: the supervisor must be on site and ready to step in if safety becomes a concern
Direct Treatment Codes
Once the treatment plan is approved and in place, this is where the hands-on work happens. These codes cover the day-to-day sessions where a therapist builds skills and works down problem behaviors.
→CPT 97153: Adaptive Behavior Treatment by Protocol
This is the standard one-on-one ABA session: the therapist runs the treatment plan already set for the client.
Who can perform this, and what is the payment? The rate depends on who delivers the service:
- Psychologist / BCBA-D / BCBA: $24.41 per 15-minute unit
- BCaBA: $20.91 per 15-minute unit
- RBT / BT: $19.17 per 15-minute unit
- Daily unit limit: Up to 32 units (8 hours) per day
→CPT 97154: Group Adaptive Behavior Treatment by Protocol
These are group sessions for 2 to 8 participants, with each one still working toward their own individual goals.
Who can perform this, and what is the payment? Rates are paid per participant:
- Psychologist / BCBA-D / BCBA: $10.45 per participant, per 15-minute unit
- BCaBA: $8.36 per participant, per 15-minute unit
- RBT / BT: $6.96 per participant, per 15-minute unit
- Daily unit limit: Up to 16 units (4 hours) per day
Important note on groups: a group must have 2 to 8 participants. Stay in that range, or you risk denials and penalties.
Supervision and Modification Codes
These codes give supervisors three things they can do: observe an active case, check how closely a technician is following the treatment plan, and adjust that plan in real time. Used correctly, they keep a case compliant and help improve outcomes.
→CPT 97155: Adaptive Behavior Treatment by Protocol Modification / Direction
Use 97155 when a supervisor joins a session directly. In it, the supervisor can review how the plan is progressing, guide the technician in the moment, model a technique, or change the plan on the spot if the client needs it.
- Who can perform this service: Psychologist, BCBA-D, or BCBA
- Payment rate: $38.34 per 15-minute unit
- Daily unit limit: Up to 24 units (6 hours) per day
Family and Caregiver Education Codes
Caregivers carry a large share of the ABA work that happens outside scheduled sessions, so how well they're trained is one of the bigger drivers of long-term progress.
Maryland's family-training codes split on a single question: is the child in the room? When the child is present, add the U2 modifier — that version of the service pays at a higher rate.
→CPT 97156: Family Adaptive Behavior Treatment Guidance (Without the Child Present)
Use 97156 to train a parent, guardian, or caregiver without the child there. The provider teaches ABA strategies, reviews progress, and gives guidance.
Who can perform this service, and what is the payment?
- Psychologist / BCBA-D / BCBA: $20.91 per 15-minute unit
- BCaBA: $12.21 per 15-minute unit
- Daily unit limit: Up to 16 units (4 hours) per day
- Modifier: you can deliver this by telehealth. It must be approved two-way, HIPAA-compliant audio-visual telehealth. In that case, add the GT modifier and use Place of Service 11, as Maryland Medicaid requires.
→CPT 97156 with U2 Modifier: Family Adaptive Behavior Treatment Guidance (With the Child Present)
Bill 97156 with the U2 modifier when the child is present. Here you coach the parent in real time as they practice with the child. Guiding both at once is more demanding than guiding the parent alone, so Maryland pays this service at a higher rate.
- Psychologist / BCBA-D / BCBA: $38.34 per 15-minute unit
- BCaBA: $20.91 per 15-minute unit
- Daily unit limit: Up to 16 units (4 hours) per day
Important rule: add the U2 modifier on the claim. Without it, you get paid at the lower, no-child rate.
→CPT 97157: Multiple-Family Group Adaptive Behavior Treatment Guidance
Use 97157 to train several families at once. One provider works with several sets of parents, guardians, or caregivers together. The session covers ABA strategies, treatment goals, and behavior-management techniques.
- Who can perform this service: Psychologist, BCBA-D, or BCBA
- Payment rate: $12.91 per family, per 15-minute unit
- Daily unit limit: Up to 10 units (2.5 hours) per day
Important rules:
- Each group is limited to 2 to 8 families.
- You can deliver this by approved two-way audio-visual telehealth with the GT modifier. First, though, add a completed Telehealth Readiness Checklist to the treatment plan. This applies any time you request telehealth for 97155, 97156, or 97157. Telehealth claims must also use the GT modifier with Place of Service 11.
- The service cannot be fully remote. Under Maryland rule PT 60-26, at least 25% of sessions must be face-to-face across the authorization period.
Advanced and Group Modification Codes
Sometimes a session takes an unusual turn — you might need to adapt a group's plan on the spot, or respond to a behavior that affects several participants at once.
Standard codes often don't fit those moments. The codes below do: they let you report complex clinical events and emergency responses in group settings.
→CPT 97158: Group Adaptive Behavior Treatment with Protocol Modification
Use this code when a clinician leads a group, such as a social skills or peer group, and adjusts the plan or responds to needs in real time.
- Who can perform this service: Psychologist, BCBA-D, or BCBA
- Payment rate: $10.45 per participant, per 15-minute unit
- Daily unit limit: Up to 10 units (2.5 hours) per day
Important rule: the group must have 2 to 8 participants.
→CPT 0373T: Exposure Adaptive Behavior Treatment with Protocol Modification
Use 0373T for ongoing treatment of severe behaviors. These cases need at least two extra staff members for support.
- Who can perform this service: Two or more BCaBAs, RBTs, or BTs with a psychologist, BCBA-D, or BCBA on site
- Payment rate: $52.28 per 15-minute unit
- Daily unit limit: Up to 24 units (6 hours) per day
Important rule: this mirrors the matching assessment code (0362T). The supervisor must be on site and ready to step in. You cannot deliver this service by telehealth.
New for 2026: Provider Payments Move to Zelis
Here's a change worth watching for: on June 12, 2026, Carelon shifts provider payments from PaySpan to Zelis. If your practice receives ABA reimbursements through Maryland Medicaid, have your billing team enroll with Zelis and update the payment details on file so payments keep flowing without a gap.
Clean-Claim Billing Tips for the Maryland 2026 ABA Fee Schedule
A near-perfect clean-claim rate takes more than picking the right CPT codes.
It also takes close tracking of daily limits and modifiers, plus staying ahead of Carelon on authorizations — both of which protect patient care and your revenue at the same time.
The checklist below covers eight habits that help a billing team lower denial risk and keep revenue on track.
Tip 1: Review Modifier Usage
A wrong or missing modifier can trigger a denial outright, or quietly lock a claim into a lower payment tier.
- Always add the GT modifier to telehealth services — that covers remote supervision and remote parent training
- For family training with the child in the room (97156), add the U2 modifier
- Skip the U2 modifier and the claim drops to the lower rate, costing roughly $17.43 per 15 minutes for each BCBA
Tip 2: Maintain Strict Adherence to Group Size Limits
Maryland Medicaid defines a group tightly for codes 97154, 97157, and 97158: your records need to show 2 to 8 attendees or families, no more and no fewer.
Say a group of three drops to one because two children are absent — you can no longer bill it as a group. Bill the remaining child as one-on-one treatment (97153) instead. Build a check into your routine audits that confirms attendance matches the group-size limit before you submit to Carelon.
Tip 3: Synchronize the ePREP and Carelon Portals Proactively
An authorization is only as strong as the credentials behind it, and that means two systems have to agree: ePREP (the electronic Provider Revalidation and Enrollment Portal) and the Carelon behavioral health portal. The National Provider Identifier (NPI) on file has to match in both.
New hires are the usual trip-up — if an RBT, BT, or BCBA's NPI isn't matched in both systems, their first appointment can draw an instant denial. Make portal sync a required onboarding step, and never book a new hire until their NPI is active and linked in both ePREP and Carelon.
Tip 4: Understand the On-Site Supervision Clock for Tiered Codes
The high-intensity codes are 0362T for assessment and 0373T for treatment. Billing either one requires a senior supervisor — a psychologist, BCBA-D, or BCBA — on site, meaning ready to step into the room at any moment for hands-on support or clinical guidance.
Record the on-site supervisor's name in your session notes and confirm their presence. If that supervisor leaves the building mid-session, those units drop to the standard technician rate.
Tip 5: Track Daily Units per Client to Prevent Excess Units
Every code carries a hard daily cap per client — 97153 tops out at 32 units, for example, and 97155 at 24. It's easy to go over when a technician runs long or two oversight sessions overlap, and once a client crosses the daily max, the extra units get rejected automatically.
Build hard stops into your EHR or practice management software — alerts that block a log from being entered above the daily cap for that client.
Tip 6: Eliminate Concurrent Billing Within Daily Session Logs
Concurrent billing — two providers billing the same patient at the same time — is something Maryland watches closely. A supervisor can't bill protocol modification (97155) while a technician bills direct therapy (97153) in that same window, with one exception: genuine team-based care where both are face-to-face with the client in the same session.
Train staff to run overlap audits comparing supervisor and technician schedules, and catch any overlap before claims go to Carelon.
Tip 7: Document Time Accurately to Meet the 15-Minute Rule
Maryland bills in 15-minute units, so your notes need to prove the time actually spent — a partial unit needs at least 8 minutes under the federal rule.
Each claim should show the total time spent on billable ABA services using exact start and stop times, such as 9:00 to 10:15 a.m., rather than just a unit count. Vague time notes alone can be enough for an auditor to deny payment later.
Tip 8: Audit Authorizations 30 Days Before Expiration
Carelon approves and denies authorizations, and letting one lapse by even a day creates a real headache — Carelon rarely allows late submissions or backdated approvals.
Build a rolling 30-day renewal pipeline that flags any client whose authorization expires within 30 days. That gives your team time to resubmit updated assessments (97151) and progress reports, renew the authorization, and prevent a gap in care. Each authorization lasts up to 180 days, so mark the renewal on your calendar from day one.
Conclusion
You can stay compliant and effective under the new 2026 schedule. In short, success comes down to four areas: Billing, Documentation, Authorization, Service delivery.
To succeed in each area, keep these points in mind:
- Payments follow a 15-minute model tied to each CPT code.
- The rate depends on the provider's credential and how complex the service is.
- Every service needs prior approval from Carelon.
- Know which modifiers (GT, U2, and others) each service needs, so you capture full payment.
- Every CPT code has a daily unit cap.
Tags: ABA, Fee Schedule, Maryland, Medicaid
