Georgia Medicaid has covered ABA for members under 21 with autism under the federal EPSDT authority since January 1, 2018, as Adaptive Behavior Services, contingent on the severity of the disorder and medical necessity and requiring a documented DSM-5 diagnosis (Georgia DCH; EPSDT under 42 U.S.C. 1396d(r)). The Department of Community Health reimburses these services through three Care Management Organizations that authorize and pay via provider networks, and through the GAMMIS portal, so the rate is set by the plans rather than published as a single comparable figure (Georgia DCH; Care Management Organizations). ABA may be delivered in the home, school, community, clinic, and by telehealth, though Georgia limits billable telehealth ABA to providers located in Georgia or within 50 miles of the border (Georgia DCH Part II Policies and Procedures for ASD Services and Telehealth Guidance). Commercial plans regulated by Georgia must cover ABA for individuals 20 and under, subject to a $35,000 annual cap, under Ava's Law (O.C.G.A. § 33-24-59.10).
The figures and rules on this page reflect Georgia DCH policy and Care Management Organization practice current through early 2026, and this page was last reviewed in June 2026. Georgia sets ABA rates through its Care Management Organizations rather than publishing a single comparable figure, and the telehealth and supervision rules are updated periodically (for example, a 2026 certification change for RBT supervisors). Treat every figure and rule here as a point-in-time snapshot, not a live quote. Confirm the current CMO rates, the Part II ASD and telehealth policies, and authorization rules before you model revenue or submit claims.
The nine reimbursement criteria at a glance
- Is ABA covered by Georgia Medicaid
- Who is eligible: age, diagnosis, and EPSDT
- The coverage scope: severity and the qualified professional
- The reimbursement rates
- Place of service: home, clinic, community, school, and telehealth
- The delivery system: three Care Management Organizations
- The profit engine: the direct-therapy code
- The commercial mandate: Ava's Law
- Reading Georgia profitability
- How this connects to the rest of your compliance stack
- Getting set up to bill Georgia Medicaid: the sequence
- Georgia reimbursement variables at a glance
- Frequently asked questions
- Where professional advice is essential
Is ABA covered by Georgia Medicaid
Yes. Georgia Medicaid has covered ABA for members under 21 with an autism diagnosis under the federal EPSDT authority since January 1, 2018, as Adaptive Behavior Services (Georgia DCH; EPSDT under 42 U.S.C. 1396d(r)). Coverage requires a documented DSM-5 diagnosis of autism from a licensed professional and is contingent on the severity of the disorder and medical necessity. The Department of Community Health administers behavioral health for children and eligible adults through its Care Management Organizations.
Who is eligible: age, diagnosis, and EPSDT
Medicaid ABA in Georgia is a children's benefit, running birth through age 20, requiring Georgia Medicaid enrollment, a documented DSM-5 autism diagnosis, and medical necessity, grounded in EPSDT (EPSDT, 42 U.S.C. 1396d(r)). The commercial mandate, discussed below, covers individuals 20 and under.
The coverage scope: severity and the qualified professional
Two Georgia-specific scope points matter. First, coverage is severity-scoped: the benefit is tied to the severity of the disorder and medical necessity, so the authorized level of care reflects clinical severity rather than a flat entitlement (Georgia DCH Adaptive Behavior Services). Second, Georgia relies on the board-certified behavior analyst as the qualified health care professional overseeing treatment, and a national certification change effective January 1, 2026 requires that supervisors of registered behavior technicians hold BCBA or BCaBA certification, which affects how supervision is staffed (Georgia DCH; BACB 2026 supervision requirement). Build the clinical model around documented severity and properly certified supervision.
The reimbursement rates
Rates current as of January 2026 review. Georgia sets ABA rates through its Care Management Organizations rather than publishing a single comparable figure, so this guide does not pin a per-unit dollar amount; confirm the current rates with each Care Management Organization and through the GAMMIS portal for any fee-for-service members. Code descriptions are paraphrased.
| Code | What it is (plain language) | Who delivers it | Rate basis |
|---|---|---|---|
| 97151 | Behavior identification assessment and treatment-plan development | BCBA (qualified health care professional) | CMO-set |
| 97153 | Adaptive behavior treatment by protocol (direct one-to-one therapy) | Registered behavior technician under supervision | CMO-set |
| 97155 | Treatment with protocol modification and supervision | BCBA | CMO-set |
| 97156 | Family adaptive behavior treatment guidance | BCBA | CMO-set |
Because there is no single published figure, the place of service and the Care Management Organization delivery system, covered next, are what shape access and billing.
Place of service: home, clinic, community, school, and telehealth
Georgia covers ABA across the full range of settings, with a notable geographic limit on telehealth.
- Clinic (center-based). Center-based delivery is common and is where facility-licensure and physical-plant questions arise, connecting this setting to the facility-licensure topic below.
- Home and community. Home- and community-based delivery is covered, and Georgia also offers Home and Community-Based Services for eligible children, though geographic availability is uneven across the state, which affects rural access. Georgia's Electronic Visit Verification requirement, under the federal Cures Act, applies to personal care, home health, and certain waiver services rather than to state-plan ABA specifically. Confirm current scope.
- School. Medically necessary ABA can be delivered at a school, distinct from the educational services a district provides under an individualized education program (IDEA); keep the lanes separate and document the clinical basis.
- Telehealth. ABA is allowed via telehealth per Georgia DCH, with the applicable codes, modifiers, and provider types published in the Part II Policies and Procedures for ASD Services and Telehealth Guidance, but Georgia imposes a distinctive geographic limit: telehealth ABA is only billable if the provider is located in Georgia or within 50 miles of the Georgia border (Georgia DCH Part II Telehealth Guidance). This shapes how a multistate provider can deploy telehealth into Georgia.
The operational takeaway is that Georgia supports a broad setting mix, that rural access is uneven, and that the 50-mile telehealth rule is a real constraint for out-of-state or distant providers. Capture the correct place of service on every claim.
The delivery system: three Care Management Organizations
Georgia delivers Medicaid behavioral health, including ABA, primarily through three Care Management Organizations, Amerigroup, CareSource, and Peach State Health Plan, which authorize and reimburse services via provider networks, with the GAMMIS portal supporting fee-for-service members (Georgia DCH; Care Management Organizations). Each Care Management Organization sets its own rates and authorization rules around the DCH policy, so a statewide practice contracts with multiple plans. The roster is not stable: a procurement to replace these plans is unresolved and the current contracts run on an extension, so confirm the roster before relying on it. Map the Care Management Organizations covering your members and their authorization rules.
The profit engine: the direct-therapy code
As everywhere, the economic engine is code 97153, the technician-delivered one-to-one direct therapy that fills most authorized hours, and the spread over a loaded technician wage drives margin at scale. In Georgia the rate is set by the Care Management Organization rather than published, so the realized rate must be confirmed by plan, severity scoping shapes the authorized level of care, and the telehealth geographic limit constrains remote delivery. Read the engine as plan-set, with technician productivity, authorized hours, and a strong commercial mix the levers, and the rate the thing to verify by plan.
Georgia covers ABA across every setting but caps billable telehealth to providers in Georgia or within 50 miles of the border, a geographic limit that shapes how a multistate practice can serve Georgia families remotely.
The commercial mandate: Ava's Law
Medicaid is one payer, and Georgia's commercial mandate, Ava's Law, requires state-regulated plans to cover the diagnosis and treatment of autism, including ABA, for individuals 20 and under, subject to a $35,000 annual cap, with no limit on the number of visits (O.C.G.A. § 33-24-59.10; SB 118, 2018). As with other states, the federal Mental Health Parity and Addiction Equity Act may render the dollar cap unenforceable as a less-favorable limitation, and the mandate reaches state-regulated plans, not self-funded employer (ERISA) plans. Commercial rates are negotiated. Confirm current terms with the Georgia Office of Commissioner of Insurance.
Reading Georgia profitability
Putting the pieces together, Georgia is a mid-range, managed-care-set market.
On the favorable side, ABA has been firmly covered since 2018, the settings are broad, and the commercial mandate covers a wide age band with no visit limit. On the constraining side, the rate is set by the Care Management Organizations rather than published, coverage is severity-scoped, the telehealth geographic limit constrains remote delivery, rural access is uneven, and the 2026 supervisor-certification change affects staffing. The practical read is mid-range economics where profitability turns on confirming the plan-specific rate, documented severity, technician productivity, authorized hours, and a strong commercial mix. None of this is a projection of any practice's results, and it is not financial advice; it is the reimbursement structure you would model against.
How this connects to the rest of your compliance stack
Reimbursement is where the rest of the structure turns into revenue, and place of service is the bridge to several of the other topics:
- Facility licensure and HIPAA. The clinic setting is where facility-licensure and physical-plant questions arise; home, school, and telehealth delivery interact differently. See facility licensure and HIPAA.
- Licensing and credentialing. The BCBA-as-qualified-professional model and the 2026 supervisor-certification change tie credentialing to delivery; you must contract with each Care Management Organization. See the Georgia licensing and credentialing page.
- Entity and ownership. The billing entity and its ownership are disclosed at enrollment and CMO contracting. See the Georgia entity page and the Georgia ownership page.
- Practice sale and expansion. The telehealth geographic limit and CMO structure shape multistate strategy. See practice expansion and sale.
Getting set up to bill Georgia Medicaid: the sequence
- Credential the team. Ensure BCBAs and technicians meet the qualified-professional and 2026 supervisor-certification requirements.
- Contract with the Care Management Organizations. Credential and contract with the four CMOs you intend to bill, and set up GAMMIS for any fee-for-service members.
- Establish diagnosis and severity. Obtain the DSM-5 diagnosis and document severity and medical necessity.
- Authorize. Secure authorization from the covering Care Management Organization.
- Bill by place of service. Capture clinic, home, community, school, or telehealth, observing the in-Georgia or 50-mile telehealth rule.
- Layer in commercial payers. Contract with state-regulated plans under Ava's Law (O.C.G.A. 33-24-59.10).
Georgia reimbursement variables at a glance
| Variable | Georgia value |
|---|---|
| Is ABA a Medicaid benefit? | Yes, under EPSDT, as Adaptive Behavior Services since January 1, 2018 |
| Age eligibility (Medicaid) | Birth through 20 |
| Direct-therapy rate (97153) | Set by the Care Management Organizations (no single published figure); confirm by plan |
| Coverage scope | Severity-scoped and medically necessary; DSM-5 diagnosis required; BCBA as qualified health care professional |
| Places of service | Home, clinic, community, school, and telehealth |
| Telehealth | Allowed per DCH; billable only if the provider is in Georgia or within 50 miles of the border; Part II ASD and Telehealth Guidance govern codes and modifiers |
| Electronic Visit Verification | Applies to personal care, home health, and certain waiver services, not to state-plan ABA specifically |
| Delivery system | Four Care Management Organizations plus the GAMMIS portal |
| Commercial mandate | Yes; Ava's Law; 20 and under; $35,000 annual cap, no visit limit; state-regulated plans (O.C.G.A. § 33-24-59.10) |
| Key authorities | Georgia DCH Adaptive Behavior Services and Part II policies; EPSDT (42 U.S.C. 1396d(r)); O.C.G.A. § 33-24-59.10 (SB 118, 2018) |
Frequently asked questions
Does Georgia Medicaid cover ABA, and for whom?
What does Georgia Medicaid pay for ABA?
Can ABA be delivered by telehealth in Georgia?
What is the severity-scoping requirement?
Do commercial plans in Georgia have to cover ABA?
Where professional advice is essential, not optional
In Georgia the things to get right are confirming the plan-set rate, documenting severity, the 50-mile telehealth limit, the 2026 supervisor-certification requirement, and the multi-CMO contracting. Confirm the Care Management Organization rates and the Part II ASD and telehealth policies, your credentialing and CMO contracts, and your place-of-service workflow with a credentialing and billing specialist, and bring in counsel where reimbursement meets entity, ownership, and facility licensure. Treat the figures here as a modeling starting point, not a projection of results, and not financial advice.
The governing authorities to know are the Georgia DCH Adaptive Behavior Services and Part II policies, the EPSDT authority (42 U.S.C. 1396d(r)) that grounds the children's benefit, and the commercial autism mandate (O.C.G.A. § 33-24-59.10, Ava's Law), read together with federal mental-health parity.
This page describes CMO-set rates and rules that change. The Georgia Department of Community Health, each Care Management Organization, and the Georgia Office of Commissioner of Insurance provide current figures. Neither this page nor any secondary source should be relied on in place of direct verification, and nothing here is a revenue or profit projection.