The reimbursement table in 441 IAC 79.1 lists "Applied behavior analysis," with the basis "Fee schedule in effect 7/1/22" (441 IAC chapter 79). The rates below come from the Iowa Medicaid open fee schedule for provider type 62, Behavioral Health, which the HHS page labels "Open Fee Schedules (Updated October 2026)"; every ABA row carries an effective date of 07/01/2024 and no end date (Iowa Medicaid open fee schedule, provider type 62). No Iowa Medicaid rule retrieved names ABA as a distinct covered service with an age range, and prior authorization and managed care handling were not found.
Every ABA row on the fee schedule reads from July 1, 2024. The rules in 441 IAC chapters 77 and 78 changed effective July 1, 2026 for provider participation and telehealth. The Medicaid age range, diagnosis requirement, prior authorization, and managed care handling were not stated in any retrieved source. Confirm them with Iowa Medicaid before modeling revenue.
The reimbursement criteria at a glance
- Is ABA covered by Iowa Medicaid
- The reimbursement rates
- Telehealth and place of service
- Provider participation under 441 IAC 77.31
- 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 Iowa Medicaid: the sequence
- What this guide could not verify
- Iowa reimbursement variables at a glance
- Frequently asked questions
- Where professional advice is essential
Is ABA covered by Iowa Medicaid
Yes, as a reimbursed provider category. The 441 IAC 79.1 reimbursement table lists applied behavior analysis on a fee schedule basis (441 IAC 79.1). No rule in 441 IAC chapter 78 names applied behavior analysis as a distinct covered service. Rule 78.12 covers "behavioral health intervention," a separate category that this guide does not treat as ABA. The Behavioral Health Services Provider Manual retrieved is dated May 1, 2014 and has no ABA text. The benefit authority and effective date were not found.
The reimbursement rates
The fee schedule is published per 15-minute unit under provider type 62, Behavioral Health. The modifiers shown are those in the schedule file. The HHS page defines the behavioral modifiers HO (master's degree level) and HP (doctoral level), and it does not define HN, so this guide reports HN rows as they appear and does not say who bills them.
| Code | Description (as listed) | Modifier and rate |
|---|---|---|
| 97151 | Behavior identification assessment by physician or QHP | HO $35.73; HP $35.73 |
| 97152 | Behavior identification support assessment by one technician | HN $17.16; HO $35.73; HP $35.73 |
| 97153 | Adaptive behavior treatment by technician | HN $17.16; HO $28.59; HP $28.59 |
| 97154 | Group adaptive behavior treatment by technician | HN $17.16; HO $28.59; HP $28.59 |
| 97155 | Adaptive behavior treatment by physician or QHP | HO $36.81; HP $36.81 |
| 97156 | Family adaptive behavior treatment guidance by physician or QHP | HN $17.16; HO $28.59; HP $28.59 |
| 97157 | Multiple family adaptive behavior treatment guidance | HO $8.39; HP $8.90 |
| 97158 | Group adaptive behavior treatment by physician or QHP | HO $8.39; HP $8.90 |
(secureapp.dhs.state.ia.us Medicaid fee schedule file for provider type 62; the file's rate column is read as the per-unit rate, and the meaning of its factor code and of modifier HN is not defined on the pages retrieved) Rates for other provider types that may also bill the 9715x codes were not checked.
Telehealth and place of service
Iowa's telehealth code list, headed "Updated: 07/10/2026," shows 97151 to 97158 as allowable as audio and video and not as audio only, with an effective date of January 1, 2024. Rule 441 IAC 78.54 provides that "health care services provided through in-person consultations or through telehealth shall be treated as equivalent services for the purposes of reimbursement," effective July 1, 2026 (Iowa telehealth code list; 441 IAC 78.54). Settings other than telehealth were not found in a retrieved ABA rule.
Provider participation under 441 IAC 77.31
- Licensed behavior analysts. "Any person licensed as a behavior analyst pursuant to Iowa Code chapter 154D is eligible to participate," and a licensed behavior analyst in another state is eligible when duly licensed there (77.31(8)).
- Licensed assistant behavior analysts. They hold current certification as an assistant behavior analyst by a certifying entity and treat under the supervision of an Iowa-licensed behavior analyst, and "claims for payment for such services must be submitted by the supervising licensed behavior analyst" (77.31(9)).
- Registered behavior technicians. A current BACB registered behavior technician certification or a bachelor's degree, treating under supervision, with the supervising licensed behavior analyst submitting claims (77.31(10), effective July 1, 2026).
(441 IAC 77.31)
The commercial mandate
Iowa Code 514C.31 requires a group policy, contract, or plan to provide coverage for applied behavior analysis provided by a practitioner for the treatment of autism spectrum disorder under a treatment plan, where the policy is issued to an employer that on at least 50 percent of its working days during the preceding calendar year employed more than 50 full-time equivalent employees, and it also reaches non-state public employee plans. The covered practitioners are a physician licensed under chapter 148, a psychologist licensed under chapter 154B, and a behavior analyst licensed under chapter 154D. Coverage "may be subject to care management provisions of the applicable policy, contract, or plan, including prior authorization and prior approval." No age or dollar cap appears in the 2026 text read, which shows 2025 Acts, chapter 162 amendments. The state employee plan mandate in Iowa Code 514C.28 provides that coverage "shall not be subject to any limits on the number of visits" (Iowa Code 2026, 514C.31 and 514C.28). Whether individual or small group plans carry any ABA mandate was not verified.
Practices with in-house diagnostics versus ABA-only practices
The commercial mandate names three practitioner types, a physician, a psychologist, and a licensed behavior analyst, so a practice with an in-house physician or psychologist and an ABA-only practice both fit the statute. Iowa Medicaid's referral and diagnosis rules for ABA were not found, so the fork cannot be drawn for Medicaid from the sources read.
How this connects to the rest of your compliance stack
Participation under 441 IAC 77.31 is tied to Iowa licensure. See the Iowa Licensing page for the credential rules and the Iowa entity page for the structure analysis.
Getting set up to bill Iowa Medicaid: the sequence
- Hold the Iowa license. A behavior analyst licensed under Iowa Code chapter 154D, or licensed in another state, is eligible to participate.
- Structure the claims route. The supervising licensed behavior analyst submits claims for assistants and technicians.
- Match codes and modifiers to the fee schedule. Use the provider type 62 schedule and confirm modifier meaning with Iowa Medicaid.
- Use audio and video for telehealth. Audio only is not allowable for the 9715x codes.
What this guide could not verify
- A Medicaid rule or state plan page naming ABA as a covered service, its benefit authority, and its effective date.
- The ABA age range, diagnosis requirements, and who diagnoses or refers.
- Prior authorization for ABA, the IA Health Link managed care plans that manage it, and any hour limits.
- The meaning of the fee schedule's factor code and of modifier HN, and rates for other provider types that may bill the 9715x codes.
- Whether individual or small group commercial plans carry any ABA mandate.
Iowa reimbursement variables at a glance
| Variable | Iowa value |
|---|---|
| ABA covered by Medicaid? | Yes, fee schedule category in 441 IAC 79.1; benefit authority not found |
| Rates | Published for 97151 to 97158 under provider type 62, effective 07/01/2024 |
| Telehealth | 97151 to 97158 audio and video allowed; audio only not allowed |
| Providers | LBA (chapter 154D), licensed assistant behavior analyst, RBT; supervising LBA submits claims |
| Prior authorization | Not verified |
| Commercial mandate | Iowa Code 514C.31, employers over 50 FTEs; 514C.28 for state employees |
Frequently asked questions
Does Iowa Medicaid pay for ABA?
Is telehealth allowed?
Who submits the claim for an RBT?
Does the commercial mandate cap ABA?
Where professional advice is essential, not optional
Iowa publishes its ABA rates, which makes it one of the more transparent states in this guide, and it leaves the eligibility and authorization rules to sources this research did not find. Bring in a billing specialist to confirm modifier meaning and authorization with Iowa Medicaid and the managed care plans.
The governing authorities to know are 441 IAC 77.31, 441 IAC chapter 79, and Iowa Code 514C.31.
This page describes rules read from the Iowa Legislature's Administrative Code and Code PDFs, the Iowa Medicaid open fee schedule, and the HHS telehealth code list. The state insurance regulator, Iowa Medicaid, and each payor provide current requirements. Do not rely on this page or any secondary source in place of direct verification.