What the notice says
The Arizona Health Care Cost Containment System published a preliminary rates notice of public information for federal fiscal year 2027. Its applied behavior analysis section covers three items. Codes 97156 and 97157 now have set rates instead of By Report pricing, and the notice does not list dollar amounts or units for them in the section we read. Code 97154 with the TJ modifier is priced at $16.95 per 15 minute unit. That code can be billed only by providers delivering ABA in a community school setting where multiple technicians work with multiple patients at once, for example two providers working with three children. The notice as a whole describes fee for service rate changes effective October 1, 2026.
What we have not verified
The document is titled a preliminary notice, and we have not seen a final rate schedule or the fee schedule that lists the dollar amounts for 97156 and 97157. We do not know the date the notice was posted, so this brief carries the October 1, 2026 effective date. We have not confirmed how the changes apply to managed care plans.
Why it matters to an operator
Analysis: Moving a code from By Report to a set rate removes negotiation and documentation burden but also fixes the ceiling, so an Arizona practice should compare the published rate to its cost for that service once the fee schedule lists it. The school setting rule for 97154 with TJ is narrow, so a practice should confirm it meets the multiple technician, multiple patient condition before billing it.
If you bill ABA in Arizona, the payer and Medicaid advisory compares your billing and documentation against current rates and rules, alongside your counsel.
Book a free 30 minute scoping callEngagements are business and compliance advisory, delivered alongside your counsel, who provides legal advice. Nothing here is legal advice.
This brief rests on the primary source linked above. Education only; nothing here is legal advice.
ABAWiser provides research, analysis, and compliance advisory services. We are not a law firm, we do not provide legal advice, and no engagement creates an attorney client relationship. Dossiers track developments as they occur and may be incomplete or updated as a story evolves. Confirm any statutory or regulatory point against the primary source before acting on it.