ABA Medicaid Rates: Vermont

Vermont Medicaid — Applied Behavior Analysis, Department of Vermont Health Access

Effective 2026-07-31 LAST CHECKED 2026-08

Code	Service	Rate	Unit
97151	Behavior identification assessment by a qualified health professional · Active row is the BCBA level. Maximum 16 units; the ABA supplement limits assessment to four hours every six months.	$65.80	15 min
97152	Behavior identification supporting assessment by one technician · Technician rate, paid to all provider levels. BCBAs billing this code are paid the technician rate.	$30.00	15 min
97153	Adaptive behavior treatment by protocol, administered by a technician · Technician rate. Maximum 32 units. Prior authorization required.	$15.00	15 min
97154	Group adaptive behavior treatment by protocol, administered by a technician · Maximum 18 units. Maximum eight patients per group.	$7.50	15 min
97155	Adaptive behavior treatment with protocol modification by a qualified health professional · BCBA level. Maximum 24 units. The BCaBA row was end-dated 31 December 2025.	$49.35	15 min
97156	Family adaptive behavior treatment guidance · BCBA level. Maximum 16 units. Telehealth modifier 95 authorized.	$21.39	15 min
97157	Multiple-family group adaptive behavior treatment guidance · BCBA level. Maximum 16 units. Telehealth modifier 95 authorized.	$21.39	15 min
97158	Group adaptive behavior treatment with protocol modification · BCBA level. Maximum 16 units.	$16.45	15 min
0362T	Behavior identification supporting assessment, two or more technicians, destructive behavior · A BCBA must be on site; BCaBAs are not authorized. The former BCaBA row at $131.58 was end-dated 31 December 2025.	$52.00	15 min
0373T	Adaptive behavior treatment with protocol modification, two or more technicians, destructive behavior · Maximum 32 units. The former BCaBA row at $104.00 was end-dated 31 December 2025.	$26.00	15 min

Read before using these numbers

These fee schedule amounts are not how most Vermont Medicaid ABA is actually paid. The state's ABA supplement says the department pays for ABA using two methodologies depending on insurance status: a monthly case rate for members whose only coverage is Medicaid, and fee-for-service for members who also hold other insurance. For Medicaid-only members, providers receive a prospective tiered monthly payment and submit per-code claims as shadow claims for data collection and reconciliation.
The 2026 case-rate tiers published by the department run from $219 a month for two to six hours up to $13,667 a month for 170 hours or more, in fifteen bands. Those are monthly payments per member based on anticipated service hours, not per-code rates.
The department's own documents are not fully consistent on this. The current ABA supplement states flatly that Vermont Medicaid reimburses ABA using a fee-for-service methodology and does not mention the case rate, while the November 2025 coding deck presents the tier payments as operative from 1 January 2026. We could not resolve which governs for Medicaid-only members from official sources, and we are not going to guess.
The per-row effective dates in the fee schedule are code coverage dates, not rate dates. GCR 19-005 priced 97151 at $50.00 and 97155 at $37.50 in 2019, where the current schedule shows $65.80 and $49.35 — an increase of about 31.6 percent applied at some later date we could not find documented. The date shown above is the publication date of the schedule file we read.
The technician-rate codes are unchanged from the 2019 figures, which corroborates those five amounts across two official documents seven years apart.
The fee schedule prints no unit column. The 15-minute increment comes from GCR 19-005, whose billing increments column is code-specific rather than a blanket value — it prints 30 minutes for the team conference codes on the same table.
From 1 January 2026, BCaBAs may no longer bill 97151, 97155, 97156, 97157, 97158, 0362T or 0373T, and the corresponding fee schedule rows were end-dated. BCaBAs are paid at the technician rate for 97152, 97153 and 97154.
Also from January 2026: 97153 and 97155 may no longer be billed concurrently for the same time, several modifiers were retired, telehealth modifier 95 was added to 97155, 97156 and 97157 only, and the team conference codes were removed from the ABA benefit.
One question we could not settle: the November 2025 deck says the tier hourly rate now includes a 1 percent amount previously withheld for value-based payment. Whether the fee schedule amounts above are similarly net of that withhold is not stated. The figures are exactly as printed.

Official sources

Vermont Medicaid Fee Schedule, CPT Codes (file CPTList_20260731.xlsx) — Department of Vermont Health Access via the Vermont Medicaid provider portal, updated weekly Global Commitment Register GCR 19-005, Applied Behavior Analysis — Adaptive Behavior Group Codes Changes, Vermont Agency of Human Services, effective 1 June 2019; the document that prints the billing increment for each code Vermont Medicaid Applied Behavior Analysis Coding Updates, Department of Vermont Health Access, 10 November 2025 — the source for the 2026 case-rate tiers and the BCaBA billing restrictions

Bill from the source, cite us for the map. If this page disagrees with the current official schedule, the schedule wins — and we want to know:

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