The ND Medicaid Autism ABA policy carries a revision date of February 2025, and the Professional Services fee schedule is labeled "Data Updated as of October 1 2026" (ND Medicaid ABA policy; ND Medicaid Professional Services Fee Schedule). No ABA state plan amendment and no North Dakota Administrative Code ABA text were read. The policy cites EPSDT authority under NDAC 75-02-02.
The fee schedule lists each code's rate but its short descriptions do not state the unit length for 97151 to 97156. Only 0373T states 15 minutes. Confirm the unit length before converting these rates to hourly figures.
The reimbursement criteria at a glance
- Is ABA covered by North Dakota Medicaid
- Who is eligible
- Rates
- Place of service and telehealth
- Service 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
- North Dakota reimbursement variables at a glance
- Frequently asked questions
- Where professional advice is essential
Is ABA covered by North Dakota Medicaid
Yes. The policy states: "ABA services are regulated by the following: 42 CFR Chapter IV, Subchapter C - Medical Assistance Programs; EPSDT North Dakota Administrative Code 75-02-02." The Department's January 20, 2025 testimony states: "Currently in ND Medicaid, ABA therapy is covered for children under 21 years of age with an autism spectrum disorder diagnosis" (ND Medicaid ABA policy; DHHS testimony on SB 2190).
Who is eligible
A child must "be under 21 years of age," "have an autism spectrum disorder diagnosis from their primary care provider (PCP) or licensed medical care provider qualified to diagnose autism spectrum disorder," and "have an annual North Dakota Health Tracks (EPSDT) screening completed at a public health unit or by a PCP," with comments that "must support and recommend Autism ABA services." Approved children "will receive a letter of approval from ND Medicaid to take to their provider" (ND Medicaid ABA policy).
Rates
The Professional Services fee schedule, "Data Updated as of October 1 2026," lists the following autism ABA rates. The fee schedule notes that the service "is only billable by providers that are enrolled to provide ABA services to children diagnosed with Autism Spectrum Disorder," and each covered code is marked covered through age 20 only with telehealth allowed (ND Medicaid Professional Services Fee Schedule, October 2026).
| Code | Description (as listed) | Rate |
|---|---|---|
| 97151 | Behavior identification assessment by physician or QHP | $31.76 |
| 97152 | Behavior identification support assessment by one technician | $23.51 |
| 97153 | Adaptive behavior treatment by technician | $10.81 |
| 97154 | Group adaptive behavior treatment by technician | $2.72 |
| 97155 | Adaptive behavior treatment by physician or QHP | $31.76 |
| 97156 | Family adaptive behavior treatment guidance by physician or QHP | $29.48 |
| 0373T | Adaptive behavior treatment, each 15 minutes | $12.99 |
97157 and 97158 are listed as not covered. No H or T codes appear in the Autism category. The unit length for 97151 to 97156 is not stated in the schedule.
Place of service and telehealth
"Services can occur within the home, community, or a provider's facility." Services in school, as approved on the Individualized Education Program or other educational plan, "must still have a care plan written by Board Certified Behavior Analyst (BCBA)," and public schools providing ABA through the IEP process may enroll. For telehealth, the policy refers to the telehealth chapter of the General Provider Manual, and the fee schedule marks each covered ABA code as telehealth allowed (ND Medicaid ABA policy; fee schedule).
Service authorization
"Agency/ School will submit a web-based Service Authorization request twice per year (annual and 180-day update)," with the care plan and the yearly approval letter attached. "Approval for Autism ABA services is a twelve-month period; annual review of medical necessity is required." The care plan states the weekly hours per code with justification, "majority requested provided by an RBT" (ND Medicaid ABA policy). The Department's testimony adds: "Reassessment of ABA services is required every 180 days" (DHHS testimony on SB 2190, January 20, 2025). Whether a managed care plan authorizes ABA and whether any hour cap exists were not verified.
Provider qualifications
"Medicaid payment is made only to providers who are actively enrolled in the ND Medicaid program." Service Oversight must be a licensed BCBA, a licensed BCBA-D, a registered behavior analyst, or a licensed clinical psychologist. Skills Trainers may be an RBT, a board certified autism technician (BCAT), a registered behavior analyst, a BCaBA, and other listed clinicians. Degreed staff may enroll to provide skills training but "must become a registered behavior technician or board certified autism technician within six months of enrollment," and skills training "must be supervised by a practitioner qualified to provide Service Oversight" (ND Medicaid ABA policy). See the North Dakota Licensing page.
The commercial mandate
No autism or ABA insurance mandate was located. A text search of North Dakota Century Code chapters 26.1-36 (accident and health insurance) and 54-52.1 (public employees uniform group insurance) for "autis" and "behavior anal" returned no matches. Other code chapters were not checked, so this is a finding about those two chapters and not a statement about all of North Dakota law.
Practices with in-house diagnostics versus ABA-only practices
Eligibility requires an autism diagnosis from a primary care provider or a licensed provider qualified to diagnose, and Service Oversight can be a licensed clinical psychologist. A practice with an in-house psychologist can combine diagnosis and oversight, while an ABA-only practice needs a BCBA for oversight and an outside diagnostician.
How this connects to the rest of your compliance stack
See the North Dakota Licensing page for the credential posture and the North Dakota entity page for the structure analysis.
What this guide could not verify
- The ABA state plan amendment and the text of NDAC 75-02-02 as it applies to ABA.
- The unit length for 97151 to 97156.
- Whether any managed care plan authorizes ABA, and any hour cap.
- Licensure as a separate enrollment condition and the Medicaid provider type.
- Any commercial mandate outside the two chapters searched.
North Dakota reimbursement variables at a glance
| Variable | North Dakota value |
|---|---|
| ABA covered by Medicaid? | Yes, EPSDT, children under 21 with an ASD diagnosis |
| Authorization | Twice yearly; 12 month approval with annual medical necessity review |
| 97153 rate | $10.81 (October 1, 2026 schedule; unit length not stated) |
| 97157 and 97158 | Not covered |
| Commercial mandate | None located in chapters 26.1-36 and 54-52.1 |
Frequently asked questions
How often does North Dakota reauthorize ABA?
Are group and multiple family codes covered?
Can degreed staff work as skills trainers?
Where professional advice is essential, not optional
North Dakota's policy and fee schedule are current and specific, which makes it one of the easier states to model once the unit lengths are confirmed. Confirm the 15 minute assumption with the Department before converting rates to hourly figures.
The governing authorities to know are the ND Medicaid Autism ABA policy and NDAC 75-02-02.
This page describes rules read from North Dakota Health and Human Services documents, legislative testimony, and the North Dakota Century Code. The Department, the Insurance Commissioner, and each payor provide current requirements. Do not rely on this page or any secondary source in place of direct verification.