Kentucky Medicaid covers applied behavior analysis as one of the behavioral health services in 907 KAR 15:010, the regulation for independently enrolled practitioners, behavioral health provider groups and multi-specialty groups. Licensed behavior analysts enroll as their own provider type (63, or 639 for a group), and the department pays ABA from its behavioral health fee schedule. Unlike many states, the regulation itself does not limit ABA to autism or to children; the managed care plans close that gap through their medical necessity criteria and claim edits.
Most members are in managed care, and the plan on the card decides authorization, criteria and payment. Kentucky has five Medicaid MCOs: Aetna Better Health of Kentucky, Humana Healthy Horizons in Kentucky, Passport by Molina Healthcare, UnitedHealthcare Community Plan, and WellCare of Kentucky. Anthem stopped being a Kentucky Medicaid MCO on January 1, 2025, so an Anthem card in Kentucky is commercial (or Medicare).
The coverage rule is 907 KAR 15:010, Section 3(3)(r). ABA "shall produce socially significant improvement in human behavior" through environmental modifications, behavioral stimuli and consequences, and direct observation, measurement and functional analysis, and may include designing, implementing and modifying treatment programs for the recipient and for the people and groups around the recipient. Every service must be medically necessary, stated in and delivered under a written plan of care, and billed by the practitioner who provided it or under whose supervision it was rendered, or by the group. The plan of care must list services and frequency, measurable goals with target dates, functional abilities and limitations or a DSM diagnosis, each assigned staff member, family involvement, termination criteria and the review date. The regulation names no age limit and no diagnosis for ABA; it does require a diagnosis to be documented in the record within three visits (assessments, screenings and crisis services excepted).[2][9][10][23][24][25][26]
DMS lists five managed care plans, and members can change plans at any time, effective the first of the following month. Anthem is not one of them: "Effective Jan. 1, 2025, Anthem is no longer a Medicaid Managed Care Organization, or MCO, in Kentucky." The plans must cover the same standard Medicaid benefits, but each runs its own ABA authorization and medical necessity criteria (Aetna Better Health and Passport use MCG; UnitedHealthcare and WellCare cite InterQual), so the first intake question is which plan is on the card.[2][9][10][23][24][25][26]
Behavioral health prior authorization was suspended for years after the COVID-19 emergency. In 2025 the General Assembly ended that: House Bill 695, Section 20, directed DMS "to, within 90 days after the effective date of this Act, reinstate all prior authorization requirements for behavioral health services in the Medicaid program that were in place and required for behavioral health services on January 1, 2020," effective June 25, 2025. DMS rescinded its own narrower March 2025 plan and told each MCO to give providers 30 days’ notice of its requirements. The plans did so: Aetna Better Health from June 25, 2025, Humana and Passport from July 1, 2025.[13][12][27][28][29][30][7]
DMS’s August 2025 chart of MCO behavioral health PA rules lists ABA (97151–97158) as requiring prior authorization at Aetna, Humana, UnitedHealthcare and WellCare, and at Passport "Yes, except for 97151 and 97152," with PA "required after 48 units (12 hrs.) per member, per Calendar Year." WellCare’s own lists released 97157 from authorization on February 1, 2026 and, on the Q4 2026 list, require it again from October 1, 2026. For fee-for-service members, DMS says those who "require prior authorization for additional services deemed medically necessary" should contact CareWise; no FFS ABA code list was found.[13][12][27][28][29][30][7]
The 2026 behavioral health fee schedule (effective April 1, 2026, revised July 15, 2026) prices ABA by who delivers it, per 15 minutes. 97151 and 97155: physician $27.50, APRN/psychologist/PA $23.37, licensed behavior analyst (modifier HO) $21.99, licensed assistant behavior analyst (modifier U4) $19.25. 97156: $21.35 / $18.13 / $17.09 / $14.94. 97157 and 97158: $10.81 / $9.18 / $8.65 / $7.57. 97152, 97153 and 97154 are "RBT Only" at $12.18 with modifier UC. 0362T and 0373T are not on the schedule. The schedule’s note limits these codes to a "Physician, LBA, LABA, Technician, or other qualified healthcare professional," and adds that a listed code and rate "is not an indication of coverage." The rates follow 907 KAR 15:015, which pays a licensed behavior analyst 60 percent and a licensed assistant behavior analyst 52.5 percent of the Kentucky Medicare physician fee schedule; MCOs are not bound to these rates and pay their contracted amounts.[5][6][3]
Fee-for-service claims go to DXC on a CMS-1500 and "must be received within 12 months of the date of service or six months from the Medicare pay date whichever is longer"; DMS applies NCCI edits. The MCO contract requires plans to allow the same filing period as FFS and to treat filing within 365 days of service as timely, to pay or deny 90 percent of clean claims within 30 days and 99 percent within 90 days, and to comply with Kentucky’s prompt-pay statute (KRS 304.17A-700 to 730); a provider can demand an in-person meeting on a clean claim unpaid for 45 days or more above $2,500. The billing provider is the practitioner "who provided the service or under whose supervision the service was rendered," or the group (907 KAR 15:010); the fee schedule puts the rendering credential on the line through the modifier (HO licensed behavior analyst, U4 licensed assistant, UC registered behavior technician). Electronic visit verification in the MCO contract covers "personal care services (PCS) and home health services," not ABA. A provider can appeal a denied MCO claim internally, then request external independent third-party review, then an administrative hearing.[7][11][2][5]
The questions that decide whether a family can start with Kentucky Medicaid, and what they have to bring. Each maps onto something intake should ask on the first call.
None in the regulation: 907 KAR 15:010’s ABA paragraph has no age limit (unlike collateral therapy, which stops at 21). Members under 21 are also protected by EPSDT, which the MCO contract requires plans to deliver.[2][11]
No physician order or referral for ABA is required by 907 KAR 15:010; the requirement is a written plan of care. Telehealth services carry "the same referral requirements as an in-person service" (907 KAR 3:170).[2][4]
907 KAR 3:170 makes its telehealth policies "supersede any in-person requirement established within KAR Title 907" (unless a law, licensing board, professional criteria or the billing code itself requires in-person), applies them to fee-for-service and to MCO coverage alike, and defines place of service as wherever the patient is, "including … the patient’s home or office, or a clinic, school, or workplace." A service is reimbursable by telehealth when it is appropriate and safe for the technology, not prohibited by the provider’s licensing board, and delivered by an enrolled provider; reimbursement is at least 100 percent of the in-person rate (an MCO may negotiate otherwise), telehealth must be denoted "by place of service or other means," and referral rules are the same as in person. Neither DMS nor any Kentucky MCO document read publishes an ABA-specific telehealth code list or modifier. The licensing board requires a Kentucky license for anyone delivering ABA by telehealth to a client located in Kentucky (201 KAR 43:100, Section 2).[4][17][2]
FFS: the federal floor applies — since January 1, 2026 the state agency decides a standard request "in no case later than 7 calendar days after receiving the request" (extendable 14 days) and an expedited one within 72 hours. MCOs: Kentucky’s MCO contract (§ 18.6) is stricter than the federal floor: a standard prior authorization is decided "no later than five (5) Days after receiving the necessary information" (contract "Day" means calendar day; "necessary information" is as defined in KRS 304.17A-607), extendable up to 14 days at the provider’s or enrollee’s request; expedited decisions within 24 hours of all necessary information; and "an untimely service authorization constitutes a Denial" that can be appealed. Federal law caps standard MCO decisions at 7 calendar days from the request for rating periods starting on or after January 1, 2026.[19][11][20]
Medicaid pays last. The MCO contract (§ 14.2) says Medicaid "shall be used as a source of payment for Covered Services only after all other sources of payment have been exhausted," and when another resource is known the plan "shall avoid payment by ‘cost avoiding’ (denying) the Claim and redirecting the provider to bill the other Third Party Resource as a primary payer" (42 CFR 433.139). So bill the commercial plan first and follow its ABA prior authorization.[11][21][2]
No diagnosis recency rule is published by DMS. The regulation requires the diagnosis to be documented within three visits and the plan of care reviewed at least every six months.[2]
Ask the plan: The member’s MCO utilization management line (or CareWise for FFS): ask how recent the diagnostic evaluation must be for an initial ABA request.
Not named by DMS for ABA. Kentucky law excludes diagnosis from the practice of ABA (KRS 319C.010(8)), so a physician, psychologist or other licensed clinician whose scope includes diagnosis must make it.[2][15]
Ask the plan: The member’s MCO utilization management line, or CareWise for FFS.
No diagnostic instrument is named in any DMS source read.[2]
Ask the plan: The member’s MCO utilization management line: ask which instruments it expects with the initial ABA request.
Coverage decides whether Kentucky Medicaid pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
907 KAR 15:010, Section 3(3)(r)4 says ABA "shall be provided by" a licensed behavior analyst, a licensed assistant behavior analyst, or an approved behavioral health practitioner (or one under supervision) "with documented training in applied behavior analysis," and that "a registered behavior technician under the supervision of an appropriate practitioner" may provide "support services." No numeric supervision ratio is set. The documentation rules carry the supervision: notes by a practitioner working under supervision must be co-signed and dated by the supervising professional within 30 days, with a monthly supervisory note on the case. 907 KAR 15:005 defines the RBT by BACB training, competency assessment and exam, within six months of hire.[2][1]
Allowed for 97155 with 97153. DMS’s December 3, 2025 letter says that "effective December 2, 2025, procedure code 97155 may be billed concurrently with procedure code 97153 when the patient is present, and the qualified health professional is directing the technician who is implementing a modified treatment protocol," and treatment must still be medically necessary and in the plan of care. Separately, 907 KAR 15:010 bars paying more than one provider for a service to the same recipient during the same time period. DMS’s behavior analyst provider page repeats it as a duplication rule: "Kentucky Medicaid will not reimburse for a service provided to a beneficiary by more than one provider of any program in which the service is covered during the same time period." Neither source addresses ABA during a speech or occupational therapy session.[14][2][7]
No ABA hour or unit cap appears in 907 KAR 15:010 or on the 2026 fee schedule (which has no maximum-units column). DMS applies National Correct Coding Initiative edits to FFS claims. Passport by Molina’s 48-units-a-year threshold is a PA trigger, not a cap.[2][5][7][12]
Under 907 KAR 15:010, Section 6, service notes must be made within 48 hours of each visit, say whether the service was face-to-face or telehealth, state a start and end time, and be "recorded and signed by the rendering behavioral health practitioner" with the practitioner’s professional title; "initials, typed signatures, or stamped signatures shall not be accepted" (compliant electronic signatures are allowed under Section 9). Notes by a practitioner under supervision are co-signed by the supervisor within 30 days, and the plan of care is reviewed at least every six months.[2]
907 KAR 15:010 sets no setting restriction for ABA, and 907 KAR 3:170 defines telehealth place of service as wherever the patient is, including home, clinic or school. Kentucky’s licensure law exempts people "providing applied behavior analysis services to an individual in a public school setting" (KRS 319C.020), and the regulation excludes services to residents of nursing facilities and ICFs/IID.[2][4][16]
Billed by the individual approved practitioner "who provided the service or under whose supervision the service was rendered," or by the behavioral health provider group or multi-specialty group on whose behalf it was rendered; DMS will not pay a service billed by an entity that is not a billing provider (907 KAR 15:015). The fee schedule identifies the rendering level by modifier: HO for a licensed behavior analyst, U4 (required) for a licensed assistant behavior analyst, UC (required) for an RBT on 97152–97154.[2][3][5]
Yes. ABA is a covered behavioral health service under 907 KAR 15:010, delivered by licensed behavior analysts, licensed assistant behavior analysts and trained practitioners, with RBTs providing support services. Most members get it through one of five MCOs.
No. DMS says Anthem stopped being a Kentucky Medicaid MCO on January 1, 2025. The five plans are Aetna Better Health of Kentucky, Humana Healthy Horizons in Kentucky, Passport by Molina Healthcare, UnitedHealthcare Community Plan and WellCare of Kentucky.
The 2026 FFS schedule pays per 15 minutes: 97153 (RBT) $12.18; 97151 and 97155 $21.99 for a licensed behavior analyst and $19.25 for a licensed assistant; 97156 $17.09 for a licensed behavior analyst. MCOs pay contracted rates.
Yes, since December 2, 2025, when the patient is present and the qualified professional is directing the technician through a modified protocol (DMS letter of December 3, 2025).
Not without a Kentucky license. The Applied Behavior Analysis Licensing Board requires anyone delivering ABA by telehealth to a client located in Kentucky to be licensed by the board (201 KAR 43:100), and KRS 319C.090 provides the route for someone licensed elsewhere. Medicaid telehealth also requires an enrolled provider.
FFS: 12 months from the date of service (or six months from the Medicare payment, if longer). The MCO contract treats claims within 365 days of service as timely, and each plan’s manual states the same 12-month/365-day limit.
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.
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