--- title: "Alaska Medicaid ABA coverage: the intake guide." url: "https://carelu.com/payers/alaska-medicaid" markdown_url: "https://carelu.com/payers/alaska-medicaid.md" state: AK (Alaska) payer: Alaska Medicaid kind: State Medicaid program description: "How Alaska Medicaid covers ABA: autism services for recipients under 21 under 7 AAC 135.350, paid fee-for-service with no managed care plans, no prior authorization since July 2025, published FY2027 rates, and an Alaska behavior-analyst license for every rendering BCBA." last_reviewed: October 2026 --- # Alaska Medicaid ABA coverage: the intake guide. _Payer Guide · Alaska Medicaid · Last updated October 2026 · 21 primary sources_ > Fee-for-service only (no MCOs, ASO ended 2024); autism services under 21 per 7 AAC 135.350, no prior auth since 7/1/2025, FY2027 rates up sharply. Alaska Medicaid pays for applied behavior analysis as "autism services" under 7 AAC 135.350, for recipients under 21 with an autism spectrum disorder diagnosis. Alaska is unusual in two ways that change the whole intake workflow. There are no Medicaid managed care plans: Alaska pays providers directly, fee-for-service. And since July 1, 2025 the state has removed the prior-authorization requirement for autism services, so a new case starts with an assessment and a treatment plan rather than a service-authorization packet. For an agency entering the Alaska Medicaid market, the gates are enrollment, not authorization. Each behavior analyst enrolls as an independent provider, and each licensed assistant behavior analyst and autism behavior technician enrolls separately as a rendering provider, with a criminal history check. Every rendering BCBA in the state needs an Alaska behavior-analyst license. The rates are published and rose sharply on July 1, 2026 (97153 now $31.95 per 15 minutes). ## Prior authorization and diagnosis at a glance - **Prior auth for the assessment**: No. Since July 1, 2025 the department has removed prior-authorization requirements for autism services; 7 AAC 135.040(c)(19) lists "autism services provided in accordance with 7 AAC 135.350" among services that need no prior authorization, and the 97151 assessment is covered "for a new or returning patient" when a licensed behavior analyst or assistant conducts it [12][1][2][11] - **Prior auth for treatment**: No, since July 1, 2025: regulation project 2024200550 set out to "remove certain prior authorization requirements for payment for autism services" and to "remove prior authorization requirements for related additional recipient services," adopted effective July 1, 2025. One stale line remains: 7 AAC 135.350(m) still tells providers to request "additional authorized periods" 14 days before a period ends, citing a repealed subsection [12][1][2][11] - **Autism diagnosis required?**: Yes. The recipient must "have a qualifying diagnosis of autism spectrum disorder, as determined by either a mental health professional as defined in AS 47.30.915 or a health care professional who is qualified" to diagnose ASD in children (7 AAC 135.020(e)(2)), and the clinical record must hold verification of that diagnosis [1][2][16] ## At a glance - **Covers ABA?:** Yes: autism services for recipients under 21 with an ASD diagnosis (7 AAC 135.020(e), 135.350) - **Structure:** Fee-for-service only: no MCOs; HMS Gainwell is fiscal agent; the Optum ASO ended Dec. 31, 2024 - **Prior auth:** None for autism services since July 1, 2025 - **Rates (per 15 min, from 7/1/2026):** 97151/97155/97156 $41.97 · 97153 $31.95 · 97154 $11.47 · 97157/97158 $15.19 - **Who may deliver:** Licensed behavior analyst; licensed assistant behavior analyst or autism behavior technician (RBT/BCAT or similar) under supervision, each separately enrolled - **Licensure:** Alaska license required (AS 08.15); BACB certification is a prerequisite - **Timely filing:** 12 months from date of service (7 AAC 145.005(c)) ## Who is covered, and why there is no health plan to call The eligibility rule is 7 AAC 135.020(e). To be eligible for autism services a recipient must "be under 21 years of age," have "a qualifying diagnosis of autism spectrum disorder, as determined by either a mental health professional as defined in AS 47.30.915 or a health care professional who is qualified based on that individual’s scope of practice, training, education, and experience to assess and diagnose autism spectrum disorders in children," and have documentation from a licensed behavior analyst, built on the 7 AAC 135.350 assessment, showing functional impairments, delays or repetitive behaviors that keep the child from adequately participating in home, school or community activities (or that endanger the child or others), and that the services "are expected to result in measurable improvement." AS 47.30.915 lists the mental health professionals: licensed physicians and psychiatrists, clinical psychologists and psychological associates, APRNs and psychiatric RNs with a master’s degree, licensed marital and family therapists, professional counselors and clinical social workers, and supervised master’s-level clinicians. [1][16][15][14][10][13] Alaska Medicaid has no managed care organizations. The Department of Health told the House Finance Committee in February 2025 that "Alaska operated under a fee-for-service model," in which the department "paid providers directly upon submission of claims," unlike states that contract with insurance companies. Behavioral health once ran through an administrative services organization, Optum Alaska, but Optum’s own notice says that contract "ends on Dec. 31, 2024," and the department now uses HMS Gainwell as fiscal agent for "provider enrollment, provider inquiry, claims processing, service authorizations, appeals." So there is no MCO or ASO guide for Alaska: the card is Alaska Medicaid, and the rules below are the state’s. Agency providers (community behavioral health services providers) also need Department of Health approval for autism services under 7 AAC 135.350. [1][16][15][14][10][13] ## No prior authorization since July 1, 2025 With CMS approval, Alaska had suspended service-authorization requirements for state plan behavioral health services through June 30, 2025, then made the change permanent in regulation. The regulation notice for project 2024200550 proposed to "remove certain prior authorization requirements for payment for autism services" in 7 AAC 135.300 and, in 7 AAC 135.350, to "update coverage for an initial behavior identification assessment for a new or returning recipient, remove the timing limitation for reassessments, and remove prior authorization requirements for related additional recipient services." The Division of Behavioral Health announced on June 6, 2025 that the 7 AAC 135 changes "were approved for adoption with an effective date of July 1, 2025," and its list of behavioral health services still needing a service authorization (submitted to HMS Gainwell) contains only 1115 residential and crisis services, not autism services. The current 7 AAC 135.040(c)(19) lists "autism services provided in accordance with 7 AAC 135.350" among services provided without prior authorization. [12][11][1][3][2] Two loose ends in the text are worth knowing. 7 AAC 135.040(c) is worded for "a community behavioral health services provider," while independent behavior analysts and behavior analyst group practices enroll under 7 AAC 135.030(a)(4)–(5); the provisions that used to impose authorization on those two provider types (7 AAC 135.300(a)(2)(B) and (a)(3)(D)) were repealed effective July 1, 2025. And 7 AAC 135.350(m) still says to "submit a request for additional authorized periods of autism services 14 days before the end of the previously authorized period," with a reassessment and an updated plan "under (g) and (h)," although (g) was repealed the same day. Read together with the department’s notice, no autism-services authorization is required; if a claim denies for a missing authorization, raise it with the Medicaid Provider Assistance Unit. [12][11][1][3][2] ## The rates: FY2027 autism services rate chart The Division of Behavioral Health publishes the only autism rate chart. From July 1, 2026, per 15-minute unit: 97151 behavior identification assessment $41.97; 97153 adaptive behavior treatment by protocol (technician) $31.95; 97154 group treatment by protocol $11.47; 97155 protocol modification $41.97; 97156 family treatment guidance $41.97; 97157 multiple-family group guidance $15.19; 97158 group treatment with protocol modification $15.19. The FY2026 chart (effective July 1, 2025) paid much less: 97151 and 97155 $29.78, 97153 $22.63, 97154 $9.04, 97156 $18.69, 97157 $7.47, 97158 $11.91. 97152, 0362T and 0373T do not appear on either chart. The chart is adopted by reference in 7 AAC 160.900(d)(73), with the methodology in 7 AAC 145.580, and warns that it does not fully address "payment limits, coverage limitations, mutually exclusive restrictions, or service authorization requirements." [7][8][9] ## Staffing, licensure and enrollment Autism services "may only be provided by" three provider types (7 AAC 135.300(c)): a behavior analyst enrolled as an independent provider who holds an active license "under AS 08.15.020(a), if the behavior analyst provides services in this state" (or from the jurisdiction where services are provided, if outside Alaska) and current BACB certification; a licensed assistant behavior analyst enrolled as a rendering provider; and an autism behavior technician enrolled as a rendering provider who is "currently registered by the Behavior Analyst Certification Board, currently certified by the Behavior Intervention Certification Council, or currently registered or certified by a similar organization approved by the department." Agencies can be a community behavioral health services provider employing at least one licensed behavior analyst, or a behavior analyst group practice; either must make sure each person rendering autism services is supervised and "separately enrolled." Everyone must pass the state criminal history check (7 AAC 10.900–10.990); the department "will not pay for services" by staff for whom one was not requested or who fail it. [3][4][17][19] Supervision is credential-based, not ratio-based. A behavior analyst who supervises an assistant or a technician, and an assistant who supervises a technician, "must first complete the supervisory training required by the Behavior Analyst Certification Board." An assistant behavior analyst must be supervised by a licensed behavior analyst, and a technician by a licensed behavior analyst or licensed assistant; a technician "may not design intervention or assessment plans." [3][4][17][19] ## Claims operations: filing limit, units, payment and appeals Claims go to the department’s contractor "no more than 12 months after the date of service" (7 AAC 145.005(c)), with a narrow extension for retroactive eligibility decisions. Federal rules require the state to pay 90 percent of clean practitioner claims within 30 days of receipt and 99 percent within 90 days (42 CFR 447.45(d)). Time-based codes follow 7 AAC 105.230(d)(5): bill a 15-minute unit only when direct time exceeds half the unit (8–22 minutes is one unit, 23–37 two, and so on), aggregated per date of service, with actual start and stop times; pre-populated notes or time sheets are not allowed, and records must be made within 14 days of the service and kept seven years. A denied or reduced claim can be appealed (first level) within 180 days of the remittance advice date (7 AAC 105.270(a)); a recoupment notice within 60 days. Questions on behavioral health billing go to the Medicaid Provider Assistance Unit (doh.dbh.mpassunit@alaska.gov) or HMS Gainwell’s behavioral health line, 855-293-3568. We found no source applying electronic visit verification to autism services. [5][21][4][11][9] ## Intake gates The questions that decide whether a family can start with Alaska Medicaid, and what they have to bring. - **Age limit**: Under 21. A recipient must "be under 21 years of age" to be eligible for autism services (7 AAC 135.020(e)(1)). A narrow grandfather clause in 135.020(f) keeps eligible certain waiver recipients who were receiving ABA through intensive active treatment on June 30, 2018. [1] - **Who may diagnose**: A mental health professional as defined in AS 47.30.915 (licensed physician or psychiatrist, clinical psychologist, psychological associate, APRN or master’s-level psychiatric RN, licensed marital and family therapist, professional or associate counselor, clinical social worker, or a supervised master’s-level clinician), or "a health care professional who is qualified based on that individual’s scope of practice, training, education, and experience to assess and diagnose autism spectrum disorders in children" (7 AAC 135.020(e)(2)). [1][16] - **Referral required?**: Yes, in effect. The initial behavior identification assessment must interpret information that includes "a referral from a mental health professional, as defined in AS 47.30.915, or a health care professional who is qualified" to assess and diagnose ASD in children (7 AAC 135.350(b)(1)(A)). No prior authorization is required. [2][12] - **Telehealth**: Allowed on the general Medicaid telehealth rule. The department pays for a service delivered by telehealth if it "would be covered … if delivered in person" and meets the same requirements (7 AAC 110.620), by real-time audio-video or audio-only (110.625). The provider must hold an active license under AS 08 or of the jurisdiction where the provider is located, be enrolled, register on the telemedicine business registry if required, and put "applicable telehealth modifiers and place-of-service coding" on the claim; the recipient must be present and participate, and the record must note the delivery method, the recipient’s location and consent (110.630). Not payable: a provider’s communication with a supervisor, or a supervisor’s review of a supervisee’s work (110.635), and telehealth consultation with another provider other than case management (7 AAC 135.010(d)(3)). Autism services are not on the telehealth exclusion list. No ABA-specific code list, modifier or POS was found. [6][1] - **Prior-auth decision time**: Not applicable: autism services need no prior authorization since July 1, 2025, so there is no decision clock. (For the behavioral health services that still need one, the department told providers HMS Gainwell’s expected turnaround is "5 business days, unless outreach to the provider is necessary.") [12][1][11] - **Other insurance (who pays first)**: Medicaid pays last. Federal rules make the agency reject a claim where third-party liability is established and pay only what its rate exceeds the other payment (42 CFR 433.139). Alaska requires the provider to report any payment from "health insurance, or other source" and "enter it as a credit against the charge to the department" (7 AAC 145.005(i)), and to refund or credit the department any such payment for a service it paid (7 AAC 105.250). Bill the commercial plan first, under its own authorization rules. [20][5][4] ## Delivery and billing rules Coverage decides whether Alaska Medicaid pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under. - **Supervision**: No numeric ratio. A behavior analyst supervising an assistant or autism behavior technician, and an assistant supervising a technician, must first complete the BACB’s supervisory training; an assistant behavior analyst must be supervised by a licensed behavior analyst, and a technician by a licensed behavior analyst or licensed assistant; technicians "may not design intervention or assessment plans" (7 AAC 135.300(d), (g)–(i)). Agency and group providers must ensure every individual rendering autism services is supervised and separately enrolled. [3] - **Concurrent billing (97153 + 97155)**: Allowed for 97153 with 97155. The old ban on concurrent autism billing, 7 AAC 135.350(k)(6), was repealed 5/25/2022, and 7 AAC 135.350(n) now says the department "will pay for the following autism services provided during the same 15-minute time increment": adaptive behavior treatment by protocol and adaptive behavior treatment by protocol modification. Not payable: a behavioral health rehabilitation service provided concurrently with an autism service ((k)(7)), or a clinician acting as "a different kind of paid treatment provider or caregiver at the same time" ((k)(8)). Behavioral health clinic services and required medical services may be billed the same day ((l)). [2] - **Session-note signature**: Case notes "must be dated and either signed or initialed by the individual who provided each service" (an AS 09.80-compliant electronic signature counts), must carry actual start and stop times for time-based codes, and must be made contemporaneously, meaning "not later than 14 days after the service ends"; services without contemporaneous records may not be billed (7 AAC 105.230(d)). The autism clinical record must also hold the diagnosis verification, the initial assessment and any reassessment (7 AAC 135.350(i)). [4][2] - **Place of service**: Autism services may be provided in "the recipient’s home, school, and community," a behavior analyst’s office, an outpatient clinic, or another appropriate community setting (7 AAC 135.350(j)). Not payable: services in an outpatient or acute hospital, inpatient psychiatric hospital, residential psychiatric treatment center, ICF, SNF or ICF/IID, except discharge-planning services the department prior-authorizes; time spent on school work "for the sole purpose of education," or on leisure or play "solely for the purpose of entertainment" ((k)(9)). [2] - **Bill as provider**: A licensed behavior analyst enrolls as an independent provider and bills directly; licensed assistant behavior analysts and autism behavior technicians "must enroll with the department as a rendering provider, but payment for those services will be made through the rendering provider’s supervising health care provider" (7 AAC 105.200(b)(11)–(12)). Agency and group-practice staff must each be separately enrolled (7 AAC 135.300(a)). [4][3] ## What intake should collect for Alaska Medicaid - **Alaska Medicaid ID and age:** Autism services cover recipients under 21. There is no health plan to identify: Alaska Medicaid is fee-for-service. - **Diagnosis verification:** ASD diagnosed by a mental health professional (AS 47.30.915) or another professional qualified to diagnose ASD in children; the clinical record must verify it. - **Referral:** The initial assessment must draw on a referral from a mental health professional or a qualified health care professional (7 AAC 135.350(b)(1)(A)). - **Other services list:** The assessment report must list every current service: waiver plans of care, behavioral health plans, IEPs, IFSPs, private insurance and privately funded services. - **Other insurance:** Medicaid pays last; bill the commercial plan first and credit its payment against the Medicaid claim. Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf ## Common questions ### Does Alaska Medicaid cover ABA therapy? Yes. Alaska Medicaid pays for autism services (the ABA codes 97151 and 97153–97158) for recipients under 21 with an autism spectrum disorder diagnosis, under 7 AAC 135.350. ### Does Alaska Medicaid require prior authorization for ABA? No. Since July 1, 2025 Alaska has removed prior-authorization requirements for autism services; 7 AAC 135.040(c)(19) lists them among services provided without prior authorization. ### Which Alaska Medicaid health plan handles ABA? None. Alaska Medicaid has no managed care plans; the state pays providers directly, with HMS Gainwell as fiscal agent. The Optum behavioral health ASO ended December 31, 2024. ### What does Alaska Medicaid pay for ABA? From July 1, 2026, per 15-minute unit: 97151, 97155 and 97156 $41.97; 97153 $31.95; 97154 $11.47; 97157 and 97158 $15.19. 97152, 0362T and 0373T are not on the rate chart. ### Can a BCBA licensed in another state treat an Alaska Medicaid member, including by telehealth? For services in Alaska, the Medicaid rule requires a license "under AS 08.15.020(a)," and Alaska law says no one may practice behavior analysis in the state without one; the only short route is a temporary license of up to 30 days a year for someone licensed in a substantially equivalent state. Alaska’s telehealth statute covers providers licensed in Alaska, with an out-of-state exception only for physicians’ teams treating life-threatening conditions. The Medicaid telehealth rule accepts a license from the jurisdiction where the provider is located, so ask the Medicaid Provider Assistance Unit before billing a remote out-of-state BCBA. ### What is the Alaska Medicaid timely filing limit? 12 months from the date of service (7 AAC 145.005(c)). Denied or reduced claims can be appealed within 180 days of the remittance advice (7 AAC 105.270). ## Primary sources 1. [7 AAC 135.010–135.130 — Scope, recipient eligibility (135.020(e) autism), provider enrollment, service authorization (135.040), clinical record](https://www.akleg.gov/basis/aac.asp?media=print&secStart=7.135.010&secEnd=7.135.199) 2. [7 AAC 135.350 — Autism services (current text, incl. (k)(6) repealed 5/25/2022 and (n) same-increment billing)](https://www.akleg.gov/basis/aac.asp?media=print&secStart=7.135.350&secEnd=7.135.350) 3. [7 AAC 135.300 — Autism services; provider qualifications (licensed behavior analyst, assistant, autism behavior technician)](https://www.akleg.gov/basis/aac.asp?media=print&secStart=7.135.290&secEnd=7.135.349) 4. [7 AAC 105.100–105.290 — Medicaid provider enrollment (105.200), prior authorization (105.130), provider records (105.230), other payment sources (105.250), provider appeals (105.270)](https://www.akleg.gov/basis/aac.asp?media=print&secStart=7.105.100&secEnd=7.105.290) 5. [7 AAC 145.005 — Conditions for payment (12-month claim deadline; payment from other sources)](https://www.akleg.gov/basis/aac.asp?media=print&secStart=7.145.001&secEnd=7.145.060) 6. [7 AAC 110.620–110.639 — Medicaid telehealth (scope, modalities, provider requirements, exclusions)](https://www.akleg.gov/basis/aac.asp?media=print&secStart=7.110.620&secEnd=7.110.639) 7. [Alaska DOH, Division of Behavioral Health — Medicaid Procedure Codes and Rates, Autism Services (effective July 1, 2026)](https://health.alaska.gov/media/3kyjzoiw/fy2027-autism-services-fee-schedule-2026-07-01.pdf) 8. [Alaska DOH, Division of Behavioral Health — Medicaid Procedure Codes and Rates, Autism Services (effective July 1, 2025)](https://health.alaska.gov/media/v5fhgwcf/fy26-applied-behavior-analysis-fee-schedule-v4.pdf) 9. [Alaska DOH — Behavioral Health Medicaid Provider Assistance (rate charts, provider service manuals; doh.dbh.mpassunit@alaska.gov)](https://health.alaska.gov/en/services/behavioral-health-medicaid-provider-support/) 10. [Alaska DOH — Medicaid Provider Assistance Section (HMS Gainwell fiscal agent: enrollment, claims, service authorizations)](https://health.alaska.gov/en/division-of-behavioral-health/medicaid-provider-assistance-section/) 11. [Alaska DOH, Division of Behavioral Health — Service Authorization Requirements for Select Behavioral Health Services Effective July 1, 2025 (bulletin, June 6, 2025)](https://content.govdelivery.com/accounts/AKDHSS/bulletins/3e3f1ae) 12. [Alaska Online Public Notice — Proposed changes on Medicaid behavioral health state plan service authorization (project 2024200550, published 3/28/2025)](https://aws.state.ak.us/OnlinePublicNotices/Notices/View.aspx?id=219039) 13. [Alaska DBH — Standards & Administrative Procedures for Behavioral Health Provider Services (October 9, 2023)](https://health.alaska.gov/media/1tjdgrjl/psam_bh.pdf) 14. [Optum — Transition of Alaska Medicaid Contract (BH00573-24-ALT, Sept. 5, 2024: ASO contract ends Dec. 31, 2024)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/ourNetworkMain/welcomeNtwk/alaska/AlaskaMedicaidTransition2024.pdf) 15. [Alaska House Finance Committee minutes, Feb. 13, 2025 (Department of Health: Alaska Medicaid is fee-for-service)](https://www.akleg.gov/pdf/34/M/HFIN2025-02-130902.pdf) 16. [AS 47.30.915 — Definitions ("mental health professional")](https://www.akleg.gov/basis/statutes.asp?media=print&secStart=47.30.915&secEnd=47.30.915) 17. [AS 08.15 — Behavior Analysts (license required; temporary license; exemptions)](https://www.akleg.gov/basis/statutes.asp?media=print&secStart=08.15.010&secEnd=08.15.990) 18. [AS 08.02.130 — Telehealth (licensed providers; out-of-state physician exception)](https://www.akleg.gov/basis/statutes.asp?media=print&secStart=08.02.130&secEnd=08.02.130) 19. [BACB — U.S. Licensure of Behavior Analysts (Alaska, 2014: Division of Corporations, Business and Professional Licensing)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/) 20. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139) 21. [42 CFR 447.45(d) — Medicaid timely claims processing (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-447/subpart-A/section-447.45) Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member. Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.