The Oklahoma Health Care Authority hosts its rule text with a disclaimer that its copy is unofficial; the official text is Title 317 of the Oklahoma Administrative Code, which was not fetched. The pages read carry revision marks of 09-01-25 (Oklahoma Health Care Authority, OAC 317:30-5-310 to 317:30-5-316). The rate file is a Word document with no effective date printed, so the rates' currency is not confirmed.
The four rates come from an OHCA Word file that prints no effective date. Confirm the current rates with the Authority before modeling revenue. The commercial dollar cap below is the 2016 enacted figure, which the statute adjusts annually for inflation.
The reimbursement criteria at a glance
- Is ABA covered by SoonerCare
- Who is eligible and who diagnoses
- Rates and billing
- Place of service and telehealth
- Prior authorization
- Provider qualifications and enrollment
- 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
- Oklahoma reimbursement variables at a glance
- Frequently asked questions
- Where professional advice is essential
Is ABA covered by SoonerCare
Yes. "The purpose of this Section is to establish guidelines for the provision of ABA services under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit." The reimbursement rule states that "SoonerCare shall provide reimbursement for ABA services in accordance with the Medicaid State Plan" (OAC 317:30-5-310, issued 09-12-22; 317:30-5-316, revised 09-01-25). The approved state plan page and amendment number were not fetched.
Who is eligible and who diagnoses
"The member is under twenty-one (21) years of age with a definitive diagnosis of an Autism Spectrum Disorder (ASD)" from a pediatric neurologist or neurologist, developmental pediatrician, licensed psychologist, psychiatrist or neuropsychiatrist, another licensed physician experienced in ASD, or an interdisciplinary team, within Oklahoma or within 50 miles of the border. "Screening scales are not sufficient to make a diagnosis." A comprehensive diagnostic evaluation or clinical assessment is completed at first initiation and "should be no older than two (2) years old" (OAC 317:30-5-313, revised 09-01-25).
Rates and billing
The OHCA rate file lists the following per 15 minutes, and the provider application states that "the CPT codes 97151, 97153, 97155 and 97156 will be utilized for reimbursement once the provider has a contract with OHCA" (OHCA Applied Behavioral Analysis CPT Codes file; OHCA provider application page).
| Code | Description (as listed) | Rate per 15 minutes |
|---|---|---|
| 97151 | Behavioral identification assessment by qualified health professional | $23.55 |
| 97153 | Adaptive behavior treatment by protocol administered by technician | $17.35 |
| 97155 | Adaptive behavior treatment with protocol modification | $23.55 |
| 97156 | Family adaptive behavior treatment guidance | $23.55 |
"Reimbursement for covered ABA procedure codes is for direct service time. Pre and post work for the session are not reimbursed separately," and "reimbursement for ABA services is only made on a fee-for-services basis." Services are individualized and not in a group setting "except for family adaptive behavior treatment guidance," and payment is not made "to or for services rendered by a parent, legal guardian, or other legally responsible person" (OAC 317:30-5-316, revised 09-01-25). Rates for 97152, 97154, 97157, and 97158 were not found.
Place of service and telehealth
"ABA may be provided in a variety of settings, including home, community, or clinical." ABA services "are not allowed in a daycare setting or school setting, without OHCA approval. If approved, it will be time-limited to three (3) months or less," and services "in the school/daycare setting as a shadow, aide, or to provide general support to the child/youth" are excluded. "ABA treatment may be rendered via in-person service delivery, telehealth, or a hybrid," and for telehealth the provider "must provide the justification of how treatment will be beneficial to the member and parents(s)/guardian(s)" (OAC 317:30-5-310 and 317:30-5-314).
Prior authorization
"Eligible providers must submit an initial prior authorization request to the Oklahoma Health Care Authority (OHCA) or its designated agent. Prior authorization requests shall be granted by units for one (1) to six (6) months of ABA treatment services as clinically indicated." The functional behavior assessment is "not to exceed thirty-two (32) units (eight (8) hours)." The rule lists frequency guidelines: high frequency greater than 30 hours a week, moderate 20 to 30, targeted or focused 10 to 20, and maintenance or consultative 5 to 10 or less (OAC 317:30-5-313 and 317:30-5-314). Whether child ABA runs through SoonerSelect managed care or fee-for-service was not verified, although the reimbursement rule says payment is fee-for-service.
Provider qualifications and enrollment
A BCBA is "a master's or doctoral level independent practitioner who is certified by the national-accrediting Behavior Analyst Certification Board" and "licensed by the Oklahoma Human Services' Developmental Disabilities Services Division (DDS)." "RBTs must obtain ongoing supervision for a minimum of five percent (5%) of the hours they spend providing behavioral-analytic services each calendar month." "All contracted providers must reside in the state of Oklahoma, or within 50 miles of the Oklahoma border," and "all staff providing ABA services must be contracted with the OHCA" (OAC 317:30-5-311). BCBAs apply through the provider portal as provider type "Applied Behavior Analyst," and "BCaBAs must be employed by a SoonerCare-contracted group or agency when billing ABA services" (OHCA ABA provider application page). See the Oklahoma Licensing page.
The commercial mandate
As enacted in HB 2962, for plans issued or renewed on or after November 1, 2016, a health benefit plan "shall provide coverage for the screening, diagnosis and treatment of autism spectrum disorder in individuals less than nine (9) years of age, or if an individual is not diagnosed or treated until after three (3) years of age, coverage shall be provided for at least six (6) years." ABA "shall be subject to a maximum benefit of twenty-five (25) hours per week and no more than Twenty-five Thousand Dollars ($25,000.00) per year," with the Insurance Commissioner adjusting the maximum for inflation annually beginning January 1, 2018 (Oklahoma HB 2962, enrolled, effective November 1, 2016). The live codified text and later amendments were not checked, and the inflation-adjusted figure was not found.
Practices with in-house diagnostics versus ABA-only practices
Eligibility requires a definitive diagnosis from a listed provider type, and a licensed psychologist is on that list. A practice with an in-house psychologist can produce the diagnosis the rule requires, while an ABA-only practice depends on outside diagnosticians whose evaluation must be no older than two years at initiation.
How this connects to the rest of your compliance stack
See the Oklahoma Licensing page for the credential posture and the Oklahoma entity page for the structure analysis.
What this guide could not verify
- The approved Medicaid state plan page or amendment number for ABA.
- Rates for 97152, 97154, 97157, and 97158, and the effective date of the rate file.
- Whether child ABA is delivered through SoonerSelect managed care plans.
- The official Title 317 text from the Office of Administrative Rules.
- The live commercial mandate text, amendments after 2016, and the inflation-adjusted dollar cap.
Oklahoma reimbursement variables at a glance
| Variable | Oklahoma value |
|---|---|
| ABA covered by Medicaid? | Yes, EPSDT, OAC 317:30-5-310 through 317:30-5-316 |
| Billable codes | 97151, 97153, 97155, 97156 |
| 97153 rate | $17.35 per 15 minutes (file prints no effective date) |
| School or daycare | Only with OHCA approval, three months or less |
| Commercial mandate | 36 O.S. 6060.21: 25 hours per week, $25,000 per year as enacted 2016, inflation adjusted |
Frequently asked questions
Which ABA codes does SoonerCare pay?
Is telehealth allowed?
Can ABA be delivered in school?
Where professional advice is essential, not optional
Oklahoma's rules are specific, but the rate file is undated and the official rule text was not read. Confirm current rates with the Authority before modeling revenue.
The governing authorities to know are OAC 317:30-5-310 through 317:30-5-316 and 36 O.S. 6060.21.
This page describes rules read from the Oklahoma Health Care Authority's unofficial copies of Title 317 and the enrolled text of HB 2962. The Authority, the Oklahoma Insurance Department, and each payor provide current requirements. Do not rely on this page or any secondary source in place of direct verification.