On this page
- 26 per 15 minutes for 97153 by an RBT, BCaBA or Lead Analyst.
- Divide total minutes by 15. 2).
- To the recipient's SMMC plan. Recipients not enrolled in a plan stay in fee-for-service, per AHCA's Behavior Analysis Services Information page.
Where the rules live
Florida covers behavior analysis (BA) under the Florida Medicaid Behavior Analysis Services Coverage Policy, incorporated by reference in Rule 59G-4.125, F.A.C., and adopted effective February 10, 2025. Codes, modifiers and maximum fees are in the Behavior Analysis Fee Schedule, incorporated in Rule 59G-4.002. General documentation rules are in Rule 59G-1.054. Beginning February 1, 2025, BA services are reimbursed by Statewide Medicaid Managed Care (SMMC) plans: claims for services on or after that date go to the recipient's plan, and recipients not enrolled in a plan stay in fee-for-service. Plans must follow the coverage policy and may not impose more stringent coverage limits than it does (section 1.2), but their billing manuals add plan-specific rules.
Who can receive and who can render
- Recipients: under 21, with behavior that impairs a major life activity, referred by an independent physician or qualified practitioner with a physician's order and a comprehensive diagnostic evaluation (section 2.2). Eligibility must be verified each time a service is rendered (2.1).
- Lead Analyst: a BCBA, a Florida-certified behavior analyst, or a practitioner fully licensed under Chapters 490 or 491, F.S., working within scope (3.2).
- BCaBA under BCBA supervision, and RBT under BCBA or BCaBA supervision.
Tip. Check the cited source for the current version before you change a billing process.
Codes on the fee schedule
| Code | Mod | Service | Max fee / 15 min |
|---|---|---|---|
| 97151 | Behavior assessment; max 24 units per assessment | $19.05 | |
| 97151 | TS | Behavior reassessment; max 18 units | $19.05 |
| 97152 | Supporting assessment; max 8 units | $12.19 | |
| 97153 | Treatment by protocol (RBT, BCaBA or Lead Analyst) | $12.26 | |
| 97153 / 97155 | XP | Supervisee under concurrent supervision | Not reimbursed |
| 97155 | Protocol modification, Lead Analyst | $19.17 | |
| 97155 | HN | Protocol modification, BCaBA | $15.37 |
| 97156 | Family training, Lead Analyst | $19.05 | |
| 97156 | GT | Family training by telemedicine; up to 2 hours per week | $19.05 |
| 97156 | HN | Family training, BCaBA | $15.24 |
| 97154 | UN–US | Group by protocol, 2 to 6 clients | $7.58 down to $5.58 |
| 97158 | UN–US | Group with protocol modification, 2 to 6 clients | $9.58 down to $7.58 |
| 0362T / 0373T | Add-on practitioner for assessment / treatment; prior authorization and medical necessity required | $12.19 |
The maximum group size is six. Code 97157 does not appear on the fee-for-service schedule. Plans may pay different rates.
Units: the 8-minute rule
Section 8.2 says providers may only claim services performed for 8 minutes or more when computing billable 15-minute units. For services over 15 minutes, divide total minutes by 15. A remainder of 8 minutes or more counts as one unit, and a remainder under 8 is not billable. So 52 minutes is 3 units (7 minutes left over), and 53 minutes is 4 units. Use the units calculator to check a session.
Limits and exclusions worth knowing
- Up to 40 hours per week of intervention as indicated in the prior-authorized behavior plan (4.2.2). For recipients under 21, EPSDT allows more when medically necessary.
- Not covered (5.2): services on the same day as behavioral health overlay, therapeutic behavioral on-site, or therapeutic group care services; services delivered simultaneously by more than one BA provider unless medically necessary, prior authorized and in the plan; travel time; seclusion or restraint; 1:1 aide, companion or shadow services; and services not on the fee schedule.
- Supervision (8.5.1): the supervisor may be reimbursed for observing a supervisee implementing the plan; the supervisee is not reimbursed for the same time period.
- Telemedicine parent training: the Lead Analyst may provide up to two hours per week (4.2.2).
Authorization and claim type
For fee-for-service, obtain authorization from the QIO before starting services and at least every 180 days after, and request a new authorization when a new assessment is clinically required (7.2). School-based requests need the IEP or the documented alternatives the policy lists. Claims are professional (837P/CMS-1500), with the most current code, modifier and diagnosis to the highest level of specificity, including co-occurring disorders that affect medical necessity (8.2–8.4.1).
Whatever software you use, the pattern is the same: the claim is built from the session note, so most of these problems can be caught before the claim is submitted.
Watch out. Payer contracts and plan manuals can add requirements beyond the rules summarized here.
FAQ
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.
How does the 8-minute rule work for Florida ABA units?
Divide total minutes by 15. A remainder of 8 or more minutes counts as one more unit; fewer than 8 does not (coverage policy section 8.2).
Where do Florida Medicaid ABA claims go after February 1, 2025?
To the recipient's SMMC plan. Recipients not enrolled in a plan stay in fee-for-service, per AHCA's Behavior Analysis Services Information page.
What is the group size limit for Florida Medicaid ABA?
Six participants, for both 97154 and 97158 (coverage policy section 4.2.2 and the fee schedule).
Bring one denied claim. Leave with the reason.
A free 15-minute claim check. No switching software, no contract.
Related guides
Sources
- AHCA, Florida Medicaid Behavior Analysis Services Coverage Policy (Dec 2024), incorporated in Rule 59G-4.125, F.A.C.
- Florida Administrative Code, Rule 59G-4.125 (Behavior Analysis Services)
- AHCA, Behavior Analysis Fee Schedule, January 1, 2025 (incorporated in Rule 59G-4.002, F.A.C.)
- AHCA, Behavior Analysis Services Information (SMMC transition, Feb 1, 2025)
- Rule 59G-1.054, F.A.C., Recordkeeping and Documentation Requirements
Last reviewed October 2026. This page summarizes public rules and vendor pages for education; it is not legal or billing advice. Payer contracts and plan manuals can add requirements, so confirm with the payer.