The rule is Alabama Administrative Code 560-X-11-.14, whose history line reads "Amended: Published November 29, 2019; effective January 13, 2020." It lists "physical therapists, occupational therapists, speech therapists, licensed behavior analysts, chiropractors" among EPSDT-only providers, and it provides that services "must be ordered by a physician for an identified condition(s) noted during the EPSDT screening exam and provided by or under the supervision of a Licensed Behavior Analyst" (Ala. Admin. Code ch. 560-X-11). Every page on the Alabama Medicaid Agency's own website failed to load for this research, which is why no rate, place-of-service, or prior-authorization rule appears here.
The Alabama Medicaid Agency's fee schedule, billing manual, and recent provider alerts could not be retrieved. Search results suggested alerts about ABA diagnostic requirements and program oversight, but they were not read, so nothing in them is relied on. Confirm the current billing manual and alerts with the agency before submitting claims.
The reimbursement criteria at a glance
- Is ABA covered by Alabama Medicaid
- Who is eligible: age, referral, and the physician order
- Who may provide ABA, and how supervision works
- The commercial mandate
- Practices with in-house diagnostics versus ABA-only practices
- How this connects to the rest of your compliance stack
- Getting set up to bill Alabama Medicaid: the sequence
- What this guide could not verify
- Alabama reimbursement variables at a glance
- Frequently asked questions
- Where professional advice is essential
Is ABA covered by Alabama Medicaid
Yes, as an EPSDT-referred service. Alabama's rule explains that if services "are not ordinarily provided as a Medicaid benefit for children under age 21, the providers of the service will be enrolled to provide 'EPSDT only' referred care," and it names licensed behavior analysts in that group (560-X-11-.14). The rule's statutory authority line cites the State Plan, Attachment 3.1-A, 42 CFR 440.110 and 441.56(2)(c), and the Omnibus Budget Reconciliation Act of 1989.
Who is eligible: age, referral, and the physician order
Services "are covered for E.P.S.D.T. referred children under the age of 21," and they "must be ordered by a physician for an identified condition(s) noted during the EPSDT screening exam." The provider must keep an EPSDT referral form for services provided as a result of a screening, and the referral is "valid only for the time specified by the referring provider or up to a maximum of twelve (12) months" (560-X-11-.14). Who may diagnose autism for an ABA referral was not verified. A search result referenced a pediatrician specialty requirement and a later pause, but the source could not be read.
Who may provide ABA, and how supervision works
The rule states that "providers of Applied Behavior Analysis (ABA) services must be licensed by the Alabama Behavior Analyst Licensing Board." ABA services may be provided by "a Licensed Behavior Analyst, a Licensed Assistant Behavior Analyst under the supervision of a Licensed Behavior Analyst, or by an unlicensed Registered Behavior Technician under the supervision of a Licensed Behavior Analyst or Licensed Assistant Behavior Analyst." Claims "must be submitted by the Licensed Behavior Analyst," who "must supervise according to the current requirements of the Behavior Analyst Certification Board® for clinical services provided by a BCaBA or RBT." Enrollment as an EPSDT-only provider is open to providers "in state and borderline out-of-state (within 30-mile radius of the Alabama state line)" (560-X-11-.14). The rule text read refers to the Alabama Behavior Analyst Licensing Board. The Licensing page covers the 2026 act that moved licensing authority to the Department of Mental Health, so confirm which body issues the license today.
The commercial mandate
The text read for this guide is the Ward substitute to House Bill 284 (2017 Regular Session), dated May 16, 2017. It is an engrossed substitute, not the enrolled act or the codified Code of Alabama text, and the enrolled text could not be retrieved. In that substitute, a health benefit plan "shall offer coverage for cover the screening, diagnosis, and treatment of Autism Spectrum Disorder for an insured nine years of age or under" in policies issued to employers "with at least 51 employees for at least 50 percent of its working days," limited to treatment "prescribed by the insured's treating licensed physician or licensed psychologist in accordance with a treatment plan." Its ABA annual maximums were $40,000 for ages zero to nine, $30,000 for ages 10 to 13, $20,000 for ages 14 to 18, and $10,000 for age 19 and older, exceedable with the insurer's prior approval when medically necessary. The same substitute directed Medicaid and ALL Kids to cover autism treatment "in the same manner and same levels as health benefit plans" on and after December 31, 2018 (ALISON, 2017 RS, 186943-3). Search results suggested the enacted law limited coverage to age 18, which would drop the 19-and-older tier. Treat every figure in this section as unconfirmed until the enacted Act 2017-337 or the codified section is checked.
Practices with in-house diagnostics versus ABA-only practices
The order for Medicaid ABA must come from a physician after an EPSDT screening, and the commercial mandate's treatment must be prescribed by a licensed physician or licensed psychologist. A practice with a physician or psychologist on staff can keep that step in-house, subject to who may order Medicaid referrals. An ABA-only practice depends on outside referral sources for every plan of care.
How this connects to the rest of your compliance stack
The credential that gates Medicaid billing is the license covered on the Alabama Licensing page, and the entity analysis is on the Alabama entity page.
Getting set up to bill Alabama Medicaid: the sequence
- Hold the Alabama license. The rule requires ABA providers to be licensed, and claims are submitted by the licensed behavior analyst.
- Enroll as an EPSDT-only provider. Confirm the current enrollment steps with the Alabama Medicaid Agency, since the billing manual was not read.
- Obtain the physician order and referral form. The order follows an EPSDT screening, and the referral is valid for the period the referring provider sets, up to 12 months.
- Check the current alerts and billing manual. Two 2025 and 2026 agency alerts about ABA were referenced in search but not read.
What this guide could not verify
- Fee schedule rates for 97151 to 97158. Every request to the agency's website failed during the secure connection step.
- Place-of-service, school, and telehealth rules for ABA. Rule 560-X-11-.14 has no such text, and the billing manual (listed in search results as Chapter 37) could not be read.
- Prior authorization, managed care arrangements, and hour limits.
- The enrolled text and codified section of the commercial mandate, including the age cap and dollar caps.
- The agency's alerts about ABA diagnostic requirements and program oversight.
Alabama reimbursement variables at a glance
| Variable | Alabama value |
|---|---|
| ABA covered by Medicaid? | Yes, as an EPSDT-referred service (Ala. Admin. Code 560-X-11-.14, effective January 13, 2020) |
| Age | Under 21 |
| Order | Physician, for a condition noted at an EPSDT screening; referral valid up to 12 months |
| Providers | Licensed behavior analyst; LABA under an LBA; RBT under an LBA or LABA |
| Supervision | Per BACB requirements; claims submitted by the LBA |
| Rates | Not verified |
| Place of service | Not verified |
| Prior authorization | Not verified |
| Commercial mandate | Engrossed 2017 substitute read; enacted text not retrieved |
Frequently asked questions
Does Alabama Medicaid cover ABA?
Who bills the claims?
What do the rates look like?
Is the commercial mandate capped?
Where professional advice is essential, not optional
Alabama's Medicaid rule is clear on who orders and who provides ABA, and silent on the money in the text this guide could read. Bring in a billing specialist to work from the agency's current fee schedule and billing manual, and counsel on the commercial mandate's enacted terms.
The governing authority to know is Ala. Admin. Code 560-X-11-.14.
This page describes rules read from the Alabama Administrative Code and the legislature's bill files. The Alabama Medicaid Agency's own pages could not be read. The agency, the state insurance regulator, and each payor provide current requirements. Do not rely on this page or any secondary source in place of direct verification.