Mississippi Medicaid covers applied behavior analysis as "Autism Spectrum Disorder (ASD) services" under its State Plan, for members eligible for EPSDT (under 21). The Medicaid Administrative Code has no ABA chapter: Part 223 is the EPSDT part and does not mention ABA. What sets the rules is the State Plan page added by SPA 16-0020 (who may deliver ASD services), the rate page (SPA 23-0002), the ASD fee schedule and the Division’s procedure-code prior-authorization list, with Part 225 governing telehealth.
Most children are enrolled in MississippiCAN with one of three coordinated care organizations (CCOs): Magnolia Health, Molina Healthcare or TrueCare. UnitedHealthcare Community Plan left MississippiCAN and CHIP after June 30, 2025. The CCO handles authorization and payment for its members; fee-for-service members go through the Division’s UM/QIO, Telligen. For an agency, two facts come first: the BCBA needs a Mississippi Autism Board license, and every provider joins MississippiCAN through the Division’s centralized credentialing, not plan by plan.
Mississippi’s State Plan covers ASD services "pursuant to 42 C.F.R. § 440.60 Other Licensed Practitioners." Licensed physicians, licensed psychologists, mental health nurse practitioners, LCSWs, LPCs and Board Certified Behavior Analysts may provide them within scope; a BCaBA "licensed by the Mississippi Board of Autism to practice under the supervision of a MS licensed BCBA" and an RBT "under the direct supervision and direction of a BCBA or BCaBA" may provide them under supervision. The State assures that "licensed practitioners bill for the services provided by the unlicensed practitioners." The ASD fee schedule limits every code to ages 0 through 20, matching EPSDT, which Part 223 describes as all medically necessary services for "a Medicaid eligible child or youth under age twenty-one (21) years." We read the whole Administrative Code (August 2026 edition): BCBAs appear only in Part 225 as telehealth providers, and no Part sets ABA medical-necessity criteria.[1][3][9][13][10][14][15][16][11]
The Division contracts with three CCOs for MississippiCAN and CHIP: Magnolia Health, Molina Healthcare and TrueCare (licensed as Mississippi True). UnitedHealthcare Community Plan stopped covering MississippiCAN and CHIP after June 30, 2025, and its members were reassigned across the three plans. All three CCO contracts carry an "Autism Spectrum Disorder (ASD) directed payment arrangement" for MississippiCAN members under 21 with an ASD diagnosis, adopted because few members were "receiving ASD services at a low Medicaid rate," so CCO rates are set by a CMS-approved preprint fee schedule rather than freely negotiated. MississippiCAN providers must exhaust a CCO’s appeal process before asking the Division for a hearing.[1][3][9][13][10][14][15][16][11]
Fee-for-service ASD services are authorized by the Division’s UM/QIO, Telligen. Telligen prefers its Qualitrac portal and accepts its standardized Prior Authorization Form by fax at 800-524-5710 with the clinical documentation attached; "Failure to complete all fields of the form or to submit the required clinical documentation may/will result in a technical denial." The form asks for both a treating provider NPI and an ordering provider NPI. The Division’s procedure-code PA list (August 2026) requires PA on 97152–97158 under the mental health, outpatient hospital and (for 97155 and 97156) clinic service areas, and on 0362T and 0373T with the HW or HA modifier; 97151 is not on the list.[6][7][5][3][2][4]
Rates come from the ASD fee schedule, which the State Plan sets at the lesser of the provider’s usual charge or a statewide uniform fee, the greater of an actuarial rate or the January 1, 2022 rate. The July 2026 schedule pays, per 15-minute unit: 97151 $34.18 (PA blank), 97152 $41.74, 97153 $15.08, 97154 $9.42, 97155 $24.35, 97156 $24.35, 97157 $12.17, 97158 $12.17, 0362T $56.64 and 0373T $41.49, all with PA except 97151, all for ages 0–20, and every "Max Units" cell reads "MUE": "All services and maximums allowed quantities are subject to NCCI procedure-to-procedure or medically unlikely editing even if prior authorized."[6][7][5][3][2][4]
Fee-for-service claims are due "no later than three hundred sixty-five (365) calendar days from the date of service"; a claim a CCO recoups because the member moved to FFS can be filed within 365 days of service or 90 days of the recoupment. The Division defines a clean claim as one processed "without obtaining additional information," and claims under medical-necessity review are not clean. Timed codes follow Part 200 Rule 1.13: the first 15-minute unit needs at least 8 minutes of direct contact, additional units need a full 15 minutes plus at least 8 minutes of the next block, and mixed remainder minutes cannot be combined across codes. Electronic visit verification applies to the waiver, personal care, private duty nursing and home health services listed in Rule 1.14; ABA is not on that list.[8][11]
A family can appeal a denial, reduction or termination by requesting a hearing "within thirty (30) days of the notice of adverse action," and an ongoing course of treatment continues at the prior level during the appeal. Providers may request an administrative review within 90 days in the situations Rule 1.8 lists (retroactive eligibility, late adjustments, crossovers).[8][11]
Mississippi licenses behavior analysts. The BACB’s licensure table lists Mississippi (2015) with the Mississippi Autism Board, which licenses Licensed Behavior Analysts and Licensed Assistant Behavior Analysts under Miss. Code Ann. § 73-75. To be licensed as a behavior analyst a person needs at least a master’s degree, "current and active certification" as a BCBA or BCBA-D, a fingerprint-based state and FBI background check, and the Board’s other requirements, which include an oral examination the Board gives at least quarterly (Rule 3.2); licenses run three years but never past the BACB certification. Assistant behavior analysts need a bachelor’s degree, BCaBA certification and proof of supervision by a licensed behavior analyst. Technicians are not licensed: the supervising licensee registers each Registered Behavior Technician with the Board, the technician "works solely under the license of the behavior analyst," and supervision follows the BACB’s policy (Rule 9). For a BCBA licensed in another state, the statute’s exemption list (§ 73-75-5: licensed psychologists, other licensed professionals within scope, supervised technicians, family members, trainees, school employees) does not include behavior analysts licensed elsewhere, and the Board’s rules contain no telehealth provision, so plan on a Mississippi license before treating a Mississippi patient in person or by telehealth. The route is licensure by reciprocity (Rule 3.4), which still requires meeting the Rule 3.1 and 3.2 requirements; a temporary license exists only for applicants awaiting exam scores or the next oral exam, restricts practice to Mississippi and requires supervision. The autism mandate ties into this: a "licensed behavior analyst" in § 83-9-26 is one licensed under § 73-75-13.[17][18][19][20][1][21]
For Medicaid network entry, the CCO provider manuals describe the Division’s centralized process: since July 1, 2022 providers who want to join MississippiCAN "are now required to be enrolled, credentialed, and screened by DOM" through its Credentials Verification Organization, selecting each CCO on the Gainwell application (Magnolia’s 2026 manual). Fee-for-service billing needs Mississippi Medicaid enrollment through the MESA portal.[17][18][19][20][1][21]
The questions that decide whether a family can start with Mississippi Medicaid, and what they have to bring. Each maps onto something intake should ask on the first call.
Under 21. Every ASD code on the July 2026 fee schedule carries minimum age 0 and maximum age 20, and the PA list’s HA-modifier lines carry member age 000-020.[3][5]
Part 225 lists "Board Certified Behavior Analysts (BCBAs) or Board Certified Behavior Analyst-Doctorals (BCBA-Ds)" among the distant-site providers and the "Beneficiary’s home" among originating sites, with no telepresenter needed at home. Telehealth must be live, interactive and audiovisual, is paid at the FFS rate with "the appropriate modifier," and is not covered when the same service is not covered in person; telephone calls are not telehealth outside a declared emergency. Records need signed telehealth consent and the reason telehealth was used. Part 225 publishes no ABA code list or POS.[10]
The Division publishes no ASD decision clock for Telligen. The federal floor for the state agency applies since January 1, 2026: a standard decision "in no case later than 7 calendar days after receiving the request" (extendable 14 days) and an expedited one within 72 hours. MississippiCAN plans are held to a faster contract clock: three calendar days or two business days, 24 hours expedited.[22][16][25]
"The Division of Medicaid must be billed as the payor of last resort," and providers must file with the other payer first, except that preventive pediatric claims "including EPSDT services" are "paid in accordance with the usual payment schedule" (Part 306 Rule 1.5). Collect the other coverage and bill it; the Division recovers from it later.[12][23]
No diagnosis recency rule appears in the State Plan, fee schedule, PA list or Administrative Code.[1][13]
Blocked on: Telligen (1-855-625-7709): ask what diagnostic documentation and dates it expects with an initial ASD request.
No Mississippi Medicaid source read names who may make the ASD diagnosis for the FFS benefit.[1]
Blocked on: Telligen (1-855-625-7709) or the Division of Medicaid Office of Mental Health.
No named diagnostic instrument appears in any Mississippi Medicaid source read.[1][13]
Blocked on: Telligen (1-855-625-7709).
No written referral rule was found. Telligen’s PA form asks for an "Ordering Provider Name" and NPI alongside the treating provider, so capture the ordering clinician.[6][1]
Blocked on: Telligen (1-855-625-7709): ask whether an order or referral must accompany an ASD services request.
Coverage decides whether Mississippi 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.
The State Plan lets a Mississippi-licensed BCaBA deliver ASD services under the supervision of a Mississippi-licensed BCBA, and an RBT "under the direct supervision and direction of a BCBA or BCaBA"; licensed practitioners "assume professional responsibility" for unlicensed staff. No numeric supervision ratio is published. The Autism Board requires supervisors to follow the BACB supervision policy.[1][20]
Every ASD code’s "Max Units" on the July 2026 fee schedule is "MUE": the Medicaid NCCI medically unlikely edit sets the daily ceiling, and authorized units are set per PA. Part 200 Rule 1.13 sets the 8-minute rule for 15-minute units.[3][8]
The licensed practitioner bills: the State Plan assures that "licensed practitioners bill for the services provided by the unlicensed practitioners" (BCaBAs and RBTs). Telligen’s PA form records both the treating provider NPI and the ordering provider NPI.[1][6]
Not addressed in any Mississippi Medicaid ABA source read. The fee schedule says all codes are subject to NCCI procedure-to-procedure and MUE edits "even if prior authorized," but no rule says whether 97153 and 97155 may be billed for the same clock time.[3]
Blocked on: Telligen (1-855-625-7709) or Division of Medicaid provider services (800-421-2408): ask whether 97155 may overlap 97153 for FFS ASD services.
Part 200 Rule 1.3 requires records that "fully disclose the extent of services," in permanent form, with corrections lined through, dated and initialed; telehealth records add signed telehealth consent and the reason telehealth was used (Part 225 Rule 1.6). No Mississippi Medicaid source read says who signs an ABA session note or by when.[8][10]
Blocked on: Division of Medicaid Office of Mental Health or provider services (800-421-2408), or the CCO’s ABA documentation policy for MississippiCAN members.
The PA list carries ABA codes under mental health services, outpatient hospital and (97155, 97156) clinic service areas, but no Mississippi Medicaid source read restricts home, clinic, school or community ABA settings.[5][1]
Blocked on: Telligen (1-855-625-7709) or the Division’s provider services: ask which place-of-service codes FFS pays for ASD services.
Yes, as "ASD services" for EPSDT-eligible members under 21. Most children get it through their MississippiCAN plan (Magnolia, Molina or TrueCare); fee-for-service members go through Telligen for prior authorization.
No. Part 223 is the EPSDT part and does not mention ABA. The rules are in the State Plan (SPA 16-0020 and 23-0002), the ASD fee schedule, the procedure-code PA list and, for telehealth, Part 225.
The July 2026 ASD fee schedule pays, per 15-minute unit: 97151 $34.18, 97152 $41.74, 97153 $15.08, 97154 $9.42, 97155 and 97156 $24.35, 97157 and 97158 $12.17, 0362T $56.64 and 0373T $41.49.
Not for 97151 under fee-for-service: its PA column is blank and it is not on the PA list. 97152, 0362T and all treatment codes need PA. MississippiCAN members follow their plan’s rules.
No. UnitedHealthcare Community Plan stopped covering MississippiCAN and CHIP after June 30, 2025. The plans are Magnolia Health, Molina Healthcare and TrueCare.
No. Part 200 Rule 1.14 lists the services that need electronic visit verification (waiver personal care and respite, private duty nursing, personal care, home health); ABA is not among them.
Part 225 allows BCBAs to deliver telehealth into the home, but Mississippi’s licensure law has no exemption for behavior analysts licensed elsewhere and the State Plan expects Mississippi-licensed BCBAs, so plan on a Mississippi Autism Board license (and Medicaid enrollment) first.
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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