97158 Medicaid reimbursement rates by state
Group ABA therapy led by the analyst. 16 state Medicaid programs publish a fee-for-service rate for 97158 at the analyst level. Rates run from $2.81 in Texas to $28.13 in Virginia, with a median of $8.79.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 16
- Median rate
- $8.79units vary by state
- Highest
- $28.13Virginia
- Medicare (non-facility)
- —not on the physician fee schedule
97158 rate in every state
One like-for-like fee-for-service rate per state, highest first. Units can differ between states; the per-hour column converts time-based units.
| State | Medicaid rate | Unit | Per hour | Managed-care plans | % of Medicare | Source |
|---|---|---|---|---|---|---|
| VirginiaBehavior analyst (BCBA / licensed behavior analyst) · Virginia Medicaid (fee-for-service, DMAS) | $28.13⚠ over 3× mediansince 2021-12-01 | 15 min | $112.52 | Plans negotiate; applies out of network | — | DMAS procedure fee file cptmedical4.csv |
| GeorgiaBehavior analyst (BCBA / licensed behavior analyst) · Georgia Medicaid (fee-for-service) | $17.51since 2025-07-01 | 15 min | $70.04 | Plans negotiate; applies out of network | — | Georgia Medicaid Autism Spectrum Disorde |
| WashingtonBehavior analyst (BCBA / licensed behavior analyst) · Washington Apple Health (Medicaid) fee-for-service | $12.40since 2026-01-01 | 15 minute units | $49.60 | Plans must pay at least this | — | HCA ABA fee schedule (aba-20260701.xlsx) |
| NebraskaBehavior analyst (BCBA / licensed behavior analyst) · Nebraska Medicaid (fee-for-service) | $12.05since 2026-07-01 | 15 min | $48.20 | Plans negotiate; applies out of network | — | Nebraska Medicaid Mental Health and Subs |
| MarylandBehavior analyst (BCBA / licensed behavior analyst) · Maryland Public Behavioral Health System (specialty mental health, SUD and ABA, paid fee-for-service through the Carelon ASO) | $10.45since 2024-07-01 | 15 min | $41.80 | Paid by the state, outside plans | — | ABA Fee Schedule FY25 |
| IndianaBehavior analyst (BCBA / licensed behavior analyst) · Indiana Medicaid (fee-for-service) | $9.95since 2026-10-01 | 15 min | $39.80 | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| ColoradoBehavior analyst (BCBA / licensed behavior analyst) · Health First Colorado (Colorado Medicaid, fee-for-service) | $9.34since 2025-10-01 | 15 min | $37.36 | Not classified | — | Health First Colorado Physician Fee Sche |
| IllinoisBehavior analyst (BCBA / licensed behavior analyst) · Illinois Medicaid (HFS fee-for-service) | $9.00since 2022-01-15 | 1/4 hr | — | Plans negotiate; applies out of network | — | HFS Adaptive Behavior Support (ABS) Serv |
| FloridaBehavior analyst (BCBA / licensed behavior analyst) · Florida Medicaid (fee-for-service) | $8.58since 2026-01-01 | 15 min | $34.32 | Plans negotiate; applies out of network | — | Behavior Analysis Fee Schedule (Updated |
| PennsylvaniaBehavior analyst (BCBA / licensed behavior analyst) · Pennsylvania Medical Assistance (fee-for-service) | $8.15since 2022-07-01 | 15 min | $32.60 | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| ArizonaBehavior analyst (BCBA / licensed behavior analyst) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $6.93since 2026-10-01 | 15 min | $27.72 | Plans negotiate; applies out of network | — | AHCCCS FFS Program Capped Fee Schedule: |
| WisconsinBehavior analyst (BCBA / licensed behavior analyst) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $6.39since 2022-12-01 | 15 min | $25.56 | Paid by the state, outside plans | — | ForwardHealth max fee schedule: Behavior |
| New JerseyBehavior analyst (BCBA / licensed behavior analyst) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $5.60since 2025-01-01 | 15 min | $22.40 | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| New YorkBehavior analyst (BCBA / licensed behavior analyst) · New York Medicaid (fee-for-service) | $3.31since 2022-04-01 | 15 min | $13.24 | Not classified | — | eMedNY NYS Medicaid Applied Behavior Ana |
| MissouriBehavior analyst (BCBA / licensed behavior analyst) · Missouri MO HealthNet (fee-for-service) | $3.16since 2022-07-01 | 15 min | $12.64 | Paid by the state, outside plans | — | MO HealthNet fee schedule: Applied Behav |
| TexasBehavior analyst (BCBA / licensed behavior analyst) · Texas Medicaid (fee-for-service, TMHP) | $2.81since 2024-03-01 | 15 min | $11.24 | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Autis |
Rates marked ⚠ are more than three times the median for the same unit; they are published as shown but often reflect an office (non-facility) fee or a different scope of service. Rates are per the unit shown for each state; units can differ between states. Medicare amounts are computed from the CMS relative value file and locality cost indices with the CMS formula; states with several Medicare localities show a range. Confirm rates with the payer before billing.
Frequently asked questions
What does Medicaid pay for 97158?
It depends on the state. Of the 16 states with a published fee-for-service rate, the median is $8.79. Virginia pays the most ($28.13 per 15 min) and Texas the least ($2.81 per 15 min).
Which state pays the highest Medicaid rate for 97158?
Virginia, at $28.13 per 15 min ($112.52 per hour), effective 2021-12-01.
Do managed-care plans pay the same rate for 97158?
Not necessarily. Each state's plan contracts decide whether plans must pay at least the fee-for-service rate, pay a state-set rate, or negotiate their own. The table shows the rule for each state, cited to the contract or statute.