The Montana Medicaid ABA Services Manual, updated 09/18/2025, and the fee schedule effective July 1, 2025 are the primary sources (Montana Medicaid ABA Services Manual; ABA Fee Schedule July 1, 2025). A fee schedule effective after July 1, 2025 was not found, so a July 2026 schedule, if one exists, was not read. No ABA-specific Administrative Rules of Montana section was fetched, and the manual notes that if a manual conflicts with a rule, the rule prevails.
The rates below are from the schedule effective July 1, 2025. A later schedule was not found, but Montana updates its fee schedules each July, so confirm the current schedule before modeling revenue.
The reimbursement criteria at a glance
- Is ABA covered by Montana Medicaid
- Who is eligible and who can refer
- Rates
- Place of service and telehealth
- Authorization
- Provider qualifications
- The commercial mandate
- Practices with in-house diagnostics versus ABA-only practices
- How this connects to the rest of your compliance stack
- What this guide could not verify
- Montana reimbursement variables at a glance
- Frequently asked questions
- Where professional advice is essential
Is ABA covered by Montana Medicaid
Yes. The state plan states: "Applied Behavior Analysis (ABA) services are provided in accordance with 42 CFR 440.60(a) Licensed Practitioners and other applicable state and federal law or regulations." The amendment "clarifies that ABA services are provided for individuals under the age of 21 pursuant to EPSDT" and "was approved effective August 1, 2021" (CMS, SPA MT 21-0020).
Who is eligible and who can refer
To begin services, "the member must have a provisional qualifying diagnosis of ASD and is no older than 20 years of age; or the member is DD Eligible and is no older than 20 years of age; or the member is a Medicaid member with a provisional qualifying diagnosis of SED and is 17 years of age or younger, or the member is up to 20 years of age and enrolled in an accredited secondary school." A "physician, licensed mental health professional, nurse practitioner, or psychologist" must document the medical necessity in a prescription stating the diagnosis and that the referral is for ABA (Montana Medicaid ABA Services Manual).
To continue services beyond the initial period, the provisional diagnosis "must have been established as a qualifying diagnosis through a Diagnostic Evaluation completed by a qualified healthcare professional with expertise in the diagnostic area." The manual lists child and adolescent psychiatrist, general psychiatrist, psychiatric mental health nurse practitioner, developmental pediatrician, neurologist, neuropsychologist or psychologist, pediatrician, family physician, family or pediatric nurse practitioner, physician assistant, clinical professional counselor, and clinical social worker (Montana Medicaid ABA Services Manual).
Rates
The fee schedule effective July 1, 2025 reimburses "according to the Department's RBRVS system" under standard CPT codes, with all services billed under the BCBA's NPI and no co-pay (Montana Medicaid ABA Fee Schedule, July 1, 2025).
| Code | Service | Rate per 15 minutes |
|---|---|---|
| 97151 | Assessment, BCBA | $40.41 |
| 97151 TC | Assessment, BCaBA | $29.91 |
| 97152 | Assessment by technician | $11.36 |
| 97153 | Treatment by technician | $11.36 |
| 97154 | Group treatment by technician | $3.78 |
| 97155 | Treatment with protocol modification, BCBA | $20.46 |
| 97155 TC | Treatment with protocol modification, BCaBA | $15.17 |
| 97156 | Family guidance | $20.46 |
| 97157 | Multiple-family group guidance | $6.84 |
| 97158 | Group treatment, BCBA or BCaBA | $6.84 |
No H or T codes appear on the schedule. A schedule effective after July 1, 2025 was not found.
Place of service and telehealth
Telehealth delivery requires prior authorization: providers complete an exception request form and submit it to the Department's Developmental Disabilities Program. The request must "clearly identify why ABA Telehealth delivery is medically necessary for this member" and describe the environmental assessment for safety of the treatment setting (Montana ABA Telehealth Exception Request form). For concurrent services, ABA "must be provided and billed outside authorized treatment hours of other programs," and providers must document attempts to coordinate with community-based services (Montana Medicaid ABA Services Manual). A rule naming permitted places of service for in-person ABA was not found.
Authorization
"The package of services that will be offered within the initial 180 calendar days includes 1,260 total units of service," and "all additional units of services must be authorized before service delivery may commence." To continue past 180 days or 1,260 units, whichever comes first, "the BCBA must complete and submit the ABA Services Additional Units of Service Request form and additional required documentation," at least 14 calendar days before continued service begins. Approved additional units continue for 180 days and "may not exceed 1,260 allowable units" (Montana Medicaid ABA Services Manual). The manual names only "the Department or other designated reviewer," and whether a managed care organization is involved was not verified.
Provider qualifications
A BCBA needs current BACB certification, a master's degree from a program with a BACB approved course sequence, and "current license in accordance with the Montana Board of Psychologists." A BCaBA needs current BACB certification. An RBT needs current RBT certification, a high school diploma or equivalent, and to be at least 18 (CMS, SPA MT 21-0020). "The BCBA assumes full professional responsibility for all services provided by a BCaBA or RBT. All services are billed under the BCBA's National Provider Identifier (NPI)" (Montana Medicaid ABA Services Manual). The Montana licensure question is covered on the Montana Licensing page.
The commercial mandate
MCA 33-22-515 requires group disability policies to "provide coverage for diagnosis and treatment of autism spectrum disorders for a covered child 18 years of age or younger." Covered care includes "medically necessary interactive therapies derived from evidence-based research, including applied behavior analysis." Coverage "may be limited to a maximum benefit of $50,000 a year for a child 8 years of age or younger" and "$20,000 a year for a child 9 years of age through 18 years of age." ABA "must be provided by an individual who is licensed by the behavior analyst certification board or is certified by the department of public health and human services as a family support specialist with an autism endorsement" (Montana Code Annotated 2025, 33-22-515).
Practices with in-house diagnostics versus ABA-only practices
Montana's continued-services rule requires a confirmed diagnosis from a listed professional, and that list includes psychologists, neuropsychologists, and physicians. A practice with an in-house psychologist or physician can keep the diagnostic confirmation inside the practice, while an ABA-only practice depends on outside evaluators for the diagnosis that unlocks continued authorization.
How this connects to the rest of your compliance stack
See the Montana Licensing page for the credential posture and the Montana entity page for the structure analysis.
What this guide could not verify
- Any fee schedule effective after July 1, 2025.
- A rule naming permitted places of service for in-person ABA, and the ABA-specific Administrative Rules of Montana section.
- Whether any managed care organization is involved in ABA authorization.
- The Medicaid enrollment provider type or specialty number for BCBAs.
Montana reimbursement variables at a glance
| Variable | Montana value |
|---|---|
| ABA covered by Medicaid? | Yes, EPSDT, SPA MT 21-0020, effective August 1, 2021 |
| Eligibility | ASD or DD eligible to age 20; SED to 17 (or 20 if in secondary school) |
| Authorization | 1,260 units over 180 days; additional units by request 14 days ahead |
| 97153 rate | $11.36 per 15 minutes (July 1, 2025) |
| Commercial mandate | MCA 33-22-515: age 18 and under; $50,000 to age 8, $20,000 ages 9 to 18 |
Frequently asked questions
How many units does Montana authorize at the start?
Who bills for ABA services?
Is telehealth allowed?
What are the commercial limits?
Where professional advice is essential, not optional
Montana's ABA program is among the better documented, with a manual, a fee schedule, and a state plan amendment that agree. Confirm whether a fee schedule after July 1, 2025 has been published before you model revenue.
The governing authorities to know are SPA MT 21-0020, the Montana Medicaid ABA Services Manual, and MCA 33-22-515.
This page describes rules read from the Montana Department of Public Health and Human Services manual and fee schedule, CMS state plan documents, and the Montana Code Annotated. The Department of Public Health and Human Services, the Commissioner of Securities and Insurance, and each payor provide current requirements. Do not rely on this page or any secondary source in place of direct verification.