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Florida Medicaid ABA, from the source documents

Florida covers behavior analysis under Rule 59G-4.125 and pays it through SMMC plans since February 1, 2025. These guides summarize what the rules say and link to every source.

Sourced guides for ABA billers and owners, organized by the problem you are solving.

2 guidesUpdated October 2026Sourced from primary documents

Tip. Start with the guide that matches the denial or audit question in front of you.

Florida is changing fast. The Governor's office reported in October 2026 that AHCA has carried out more than 400 provider site visits since January, with particular attention on ABA, and that more than 220 providers have been terminated from Florida Medicaid for fraud, waste or abuse. An ABA Task Force created by HB 5003-E is due to report recommendations by December 31, 2026. The pages below stick to what the published rules and agency pages say.

Guides in this section

Florida Medicaid ABA billing guidelinesFlorida Medicaid behavior analysis billing in one page: who can render, codes and modifiers on the fee schedule, the 8-minute unit rule, the 40-hour cap, and authorization.Preparing for an AHCA site visit as an ABA providerFlorida's AHCA has done 400+ provider site visits in 2026 with a focus on ABA. What federal and Florida rules say about site visits and records access, plus a preparation checklist.ABA units to hours calculatorConvert ABA session minutes to billable 15-minute units with the 8-minute rule Florida Medicaid uses, or convert authorized units to hours.
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Common questions

What does Florida Medicaid pay for 97153?

The January 1, 2025 Behavior Analysis Fee Schedule lists a maximum fee of $12.26 per 15 minutes for 97153 by an RBT, BCaBA or Lead Analyst. SMMC plans, which pay most BA claims since February 1, 2025, may pay different rates.

Can AHCA show up without notice?

Yes. Under 42 CFR 455.432(b), enrolled providers must permit CMS, its contractors, or the state Medicaid agency to conduct unannounced on-site inspections of any and all provider locations.

Other sections

ABA denialsEach guide starts from the official X12 code definition, then walks through why ABA claims…Session notes & auditsA claim is only as strong as the note behind it. These guides list what the rules require …ABA billing software comparisonFacts each vendor publishes about itself, side by side, with links. No ratings, no rumors.…
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