New Hampshire Medicaid covers applied behavior analysis as part of EPSDT, the federal benefit for Medicaid members under 21. The state’s own rules say so in one line: ABA "is covered through the EPSDT benefit pursuant to He-W 546." We found no separate ABA program rule for home and clinic services in the He-W 500 Medicaid rules. The practical consequence is that the family’s card decides almost everything. Members enrolled in Medicaid Care Management belong to one of three health plans (AmeriHealth Caritas New Hampshire, NH Healthy Families, or WellSense Health Plan), and the plan handles ABA authorization, credentialing and payment. Only members who are not in managed care use the state’s fee-for-service path, where DHHS approves ABA on Form 272A.
For an agency trying to get into the New Hampshire Medicaid market, three facts matter up front. You need a New Hampshire Medicaid enrollment and a contract with each health plan you want referrals from; the state does not license behavior analysts, so BACB certification is the credential every payer checks; and the only published ABA rates (the fee-for-service schedule) are low, so model the plans’ contracted rates before you commit staff.
New Hampshire’s Medicaid rules define ABA as "a treatment modality that employs the process of systematically applying interventions based on the principles of learning theory to improve socially significant behaviors, and is covered through the EPSDT benefit pursuant to He-W 546." EPSDT under He-W 546 covers "all recipients under the age of 21," and services beyond ordinary limits are covered when medically necessary with prior authorization. That definition lives in He-W 589, the Medicaid to Schools rule, which is also the only place the state writes down ABA’s covered diagnoses (autism spectrum disorder or pervasive developmental disability), its provider types, and who must recommend it. We found no separate He-W rule for ABA delivered in homes and clinics.[1][2][8][4]
DHHS lists three Medicaid Care Management health plans: AmeriHealth Caritas New Hampshire, NH Healthy Families (Centene), and Well Sense Health Plan. ABA is inside those contracts, not carved out: AmeriHealth Caritas New Hampshire lists "Early and Periodic Screening, Diagnostic and Treatment Services including Applied Behavioral Analysis Coverage" as a covered service, and WellSense and NH Healthy Families both run their own ABA authorization. The state’s fee-for-service instructions make the split explicit: "If the Member is enrolled in a Managed Care Organizations (MCO) they do not have Fee-for-Service Medicaid as secondary insurance. Contact the MCO directly for SA requirements and use their Standard Authorization form." So the first intake question is which plan is on the card.[1][2][8][4]
Members not enrolled in a health plan go through DHHS. Form 272A, "Request for Service Authorization for ABA Services (Fee-for-Service (FFS) Program Only - Not for Managed Care program use)," goes by encrypted email to ServiceAuthorizationFFS@dhhs.nh.gov or fax to (603) 314-8101. It asks for the diagnosis in words, any alternate insurance, the performing therapist’s and requesting facility’s Medicaid IDs, and for each code the hours per week, total units and dates. The packet must include the physician’s order, clinical notes supporting medical necessity (therapy care plan, progress notes, and a "Face to Face PCP visit note within one year"), goals and objectives, and a letter of medical necessity, with the ABA provider certifying the services are "medically necessary and cost effective." Incomplete requests are held 30 days, not denied; once DHHS approves, the fiscal agent has "up to three business days" to create the authorization.[3][4][5][6]
Which codes need that authorization is set by the fee schedule’s SA column. On the 2026 Covered Procedures Report (run July 24, 2026) the ABA lines are: 97151 $16.43 (SA Y, max 32 units), 97153 $17.79 (SA Y, 32), 97154 $6.50 (SA N, 18; priced from 9/1/2025), 97155 $16.43 (SA Y, 24), 97156 $16.43 (SA Y, 32), and 0373T $35.58 (SA N, 32), all per 15-minute unit and, except 97154, priced since 7/1/2023. 97151 and 97153 also carry a TM-modifier line at the same rate with no SA and an 8-unit maximum. 97152, 97157, 97158 and 0362T do not appear on the schedule. These are the only published ABA rates in the state and a floor, not a guide, for plan negotiations.[3][4][5][6]
New Hampshire has no behavior analyst licensing law; the BACB’s licensure table does not list the state. The Medicaid rules therefore key ABA staffing to BACB credentials. He-W 589.04(ah) says ABA "shall be provided by" a BCBA "appropriately certified by the national Behavior Analyst Certification Board, and if supervising others, have a supervisory certification," or by a rehabilitation assistant, a board certified assistant behavior analyst, or a registered behavior technician "under the appropriate supervision of" that BCBA. It sets no numeric supervision ratio. ABA must also be "recommended by a licensed clinician who has experience in the diagnosis and treatment of autism spectrum disorder" who is a physician, psychologist, or a nurse practitioner or physician’s associate specializing in developmental medicine. In the schools program BCBAs are "performing-only" providers attached to an enrolled school provider.[1][11][3][8][9][10]
For network entry, plan on three separate applications: New Hampshire Medicaid provider enrollment through NH MMIS (Form 272A asks for the performing therapist’s Medicaid ID as well as the facility’s), then credentialing with each health plan. AmeriHealth Caritas New Hampshire states it notifies mental health providers of its credentialing decision within 30 calendar days of a clean and complete application (effective January 1, 2026); WellSense lists "applied behavioral analysts" among the practitioner types it credentials; NH Healthy Families enrolls new ABA providers through its Behavioral Health Provider Specialty Profile.[1][11][3][8][9][10]
The questions that decide whether a family can start with New Hampshire Medicaid, and what they have to bring. Each maps onto something intake should ask on the first call.
Under 21. ABA is covered "through the EPSDT benefit," and EPSDT covers "all recipients under the age of 21" (He-W 546.02). No adult ABA benefit was found.[1]
No diagnosis recency rule was found. The dated requirement on the FFS path is the PCP: Form 272A needs a "Face to Face PCP visit note within one year."[3]
Yes. ABA must be "recommended by a licensed clinician" (physician, psychologist, or developmental-medicine NP or PA) under He-W 589.04(aj), and the FFS Form 272A packet must include a signed physician’s order, a letter of medical necessity, and a PCP face-to-face visit note from within one year.[1][3][4]
The state publishes no ABA decision timeframe. The federal fee-for-service floor applies: since January 1, 2026 the state agency must decide a standard request "in no case later than 7 calendar days after receiving the request" (extendable by up to 14 days) and an expedited one "in no case later than 72 hours." On the state side, an incomplete request gets a request for more information, not a denial, and is held 30 days; after approval the fiscal agent "has up to three business days to create and mail the SA." Managed-care members follow their plan’s clock (42 CFR 438.210(d): 7 calendar days for rating periods starting on or after January 1, 2026).[12][4][14]
Medicaid pays last. "All third party obligations shall be exhausted before medicaid is billed, in accordance with 42 CFR 433.139" (He-W 546.10), and Form 272A adds that "Providers are expected to follow all third party payors requirements for payment." Medicaid pays the lesser of the patient responsibility or the difference between the primary payment and the Medicaid allowed amount, and pays nothing if the patient responsibility is zero. Denials "due to incorrect billing, non-eligible provider, or lack of medical necessity must be resolved with the primary payer, not billed to NH Medicaid," so be in the commercial network and get its ABA authorization. A primary denial for a non-covered service can be billed to Medicaid with the EOB. Keep the Medicaid SA in place too: an SA is "not a guarantee of payment."[1][3][7][13]
No NH Medicaid source read names who may make the ASD diagnosis. He-W 589.04(aj) names who must recommend ABA: a licensed clinician experienced in diagnosing and treating ASD who is a physician, psychologist, or a nurse practitioner or physician’s associate specializing in developmental medicine.[1]
Blocked on: DHHS Medicaid Medical Services (ServiceAuthorizationFFS@dhhs.nh.gov) for FFS members, or the member’s health plan for MCO members.
No named diagnostic instrument appears in any NH Medicaid source read. He-W 546 covers developmental screening "with a standardized validated tool of the provider’s choice," but says nothing about the ASD diagnostic tool.[1]
Blocked on: DHHS Medicaid Medical Services (ServiceAuthorizationFFS@dhhs.nh.gov) or the member’s health plan.
Not addressed in any NH Medicaid ABA source read (Form 272A, the SA instructions, the fee schedule, He-W 546 or He-W 589).[3][5]
Blocked on: NH Medicaid Provider Relations, (866) 291-1674, or the member’s health plan: ask which ABA codes are payable by telehealth and with which POS code.
Coverage decides whether New Hampshire 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.
No numeric ratio is published. The only written NH Medicaid ABA staffing rule, He-W 589.04(ah), requires a BCBA with a BACB supervisory certification when supervising, and lets a rehabilitation assistant, BCaBA or RBT deliver ABA "under the appropriate supervision of" that BCBA. It appears in the Medicaid to Schools rule; no separate supervision rule for home or clinic ABA was found.[1]
The 2026 fee schedule’s maximum-units column lists: 97151, 32; 97153, 32; 97154, 18; 97155, 24; 97156, 32; 0373T, 32; and 8 on the TM-modifier lines for 97151 and 97153. Authorized amounts beyond that are set per request on Form 272A (hours per week, total units, dates of service).[5][3]
School-based ABA is billed through the Medicaid to Schools program (He-W 589), where the school district is the enrolled provider and the BCBA is a "performing-only" provider. The fee schedule carries separate TM-modifier lines for 97151 and 97153 with no SA. No NH Medicaid source read restricts home, clinic or community settings.[1][5]
Form 272A asks for both the performing therapist’s Medicaid ID and the requesting facility’s Medicaid ID, so the rendering clinician is enrolled, not just the agency. In the schools program, BCBAs are "performing-only" providers that Medicaid "does not allow to independently enroll" and must be affiliated with an enrolled school provider.[3][1]
Not addressed in any NH Medicaid source read. The fee schedule lists 97153 and 97155 as separate lines with separate SA flags but says nothing about billing them for the same clock time.[5]
Blocked on: NH Medicaid Provider Relations, (603) 223-4774 or (866) 291-1674, or the NH MMIS provider-specific billing manual (Volume II) for the ABA provider type.
Form 272A must be signed by the ABA provider, certifying the services are "medically necessary and cost effective," and needs a signed physician’s order and letter of medical necessity. EPSDT providers must keep supporting records under He-W 520. No NH Medicaid source read says who signs each session note or by when.[3][4][1]
Blocked on: NH MMIS General Billing Manual Volume I (record-keeping) and the provider-specific Volume II, via nhmmis.nh.gov; or NH Medicaid Provider Relations, (866) 291-1674.
Yes, for members under 21 through EPSDT. Most children are in one of three health plans (AmeriHealth Caritas NH, NH Healthy Families, WellSense), which authorize and pay for ABA; members not in a plan use DHHS’s fee-for-service Form 272A.
No. ABA is inside the managed care contracts: the state’s FFS instructions send MCO members to their plan for authorization, and each plan runs its own ABA prior authorization.
The 2026 fee-for-service schedule pays, per 15-minute unit: 97151, 97155 and 97156 $16.43; 97153 $17.79; 97154 $6.50; 0373T $35.58. The health plans pay contracted rates, which are not published.
No. New Hampshire does not license behavior analysts. Medicaid, the plans and the commercial mandate all rely on BACB certification (BCBA, BCaBA, RBT).
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 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.
Carelu collects all of this automatically.
Every ID, document, and detail this payer requires — gathered conversationally the moment a family reaches out, with insurance verified before your team touches the file.
Get a Demo