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]
What a request must carry: Form 272A asks providers to attach the physician’s order and “clinical notes supporting the medical necessity for the requested services, including but not limited to the following: Therapy Care Plan, and progress notes, Face to Face PCP visit note within one year,” with goals and objectives specified, plus a letter of medical necessity. It sets no separate reauthorization checklist and does not ask for graphs.[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]
He-W 521.04(a): a provider "shall submit fee-for-service claims for payment to the department’s fiscal agent within 12 months of the earliest date of service, as required by 42 CFR 447.45." A denied claim that can be corrected may be resubmitted within 12 months of the earliest date of service, and MCO claims follow "the MCO contract obligation" instead, so each Granite Advantage or Medicaid Care Management plan’s manual sets its own limit.[1][15][16][5][17]
The General Billing Manual (Volume I, August 2026) adds the mechanics. Initial claims are due “within one year following the earliest date of service on the claim.” A claim filed on time but denied, and now past a year, is resubmitted on paper with Form 957X (“Override Request”) and the RA with the denial circled, and must arrive within 15 months of the date of service. Denied claims are corrected by resubmitting them as a new claim; a paid claim is corrected only through an adjustment, and resubmitting it denies as a duplicate. Medicare crossover claims are due within 12 months of the date of service. If another insurer has not answered within six months of billing, you may send Medicaid a paper claim saying so.[1][15][16][5][17]
Payment runs weekly: “The NH Medicaid program issues payment on a weekly basis for claims adjudicated in the previous week,” with one net payment and a weekly Remittance Advice. The manual publishes no submission cut-off day or time. Claim disputes go first to the fiscal agent (Provider Inquiry on the portal or Provider Relations), then to the Department in writing, then to the Administrative Appeals Unit within 30 days of the Department’s letter; MCO-enrolled providers must first exhaust the plan’s process.[1][15][16][5][17]
On the claim, providers identified as “rendering, ordering, referring, prescribing” must have an NPI on file with NH Medicaid and on the claim, and processing depends on crosswalking the NPI and taxonomy code to the Medicaid provider ID; when several locations share one NPI, taxonomy and address, processing is affected. The service authorization number is not required on the claim. ABA is billed on the CPT lines of the fee schedule; it lists no H0031 or H0032 line. DHHS’s EVV service list (updated May 2026), which applies to services delivered in the home, names home health, personal care, private duty nursing and respite codes and no ABA code, so EVV does not apply to ABA.[1][15][16][5][17]
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]
Yes, by statute. RSA 167:4-d requires the Medicaid program to “provide coverage and reimbursement for health care services provided through telemedicine on the same basis as the Medicaid program provides coverage and reimbursement for health care services provided in person,” with “no restriction on eligible originating or distant sites” (the child’s home counts) and reimbursement for “all modes of telehealth, including video and audio, audio-only, or other electronic media … for all medically necessary services.” Its list of providers who may use all modes names “Professionals certified by the national behavior analyst certification board or persons performing services under the supervision of a person certified by the national behavior analyst certification board.” So the BCBA assessment (97151/97152), supervision with protocol modification (97155) and technician and family services are inside the statute, subject to medical necessity; the statute names no in-person minimum for supervision. It is “conditioned upon review and approval of a state plan amendment,” and no NH Medicaid ABA document read publishes an ABA telehealth code list, POS or modifier.[14][3][5]
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][18]
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 document names who may make the ASD diagnosis; the General Billing Manual and the EPSDT provider manual (August 2026) are silent too. 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. LCSW: not among the professionals He-W 589.04(aj) lets recommend ABA (physician, psychologist, or developmental-medicine NP or physician's associate).[1][15][16]
Ask the plan: DHHS Medicaid Medical Services (ServiceAuthorizationFFS@dhhs.nh.gov) for FFS members, or the member’s health plan for MCO members.
No NH Medicaid document names an ASD diagnostic instrument, including the General Billing Manual and the EPSDT provider manual (August 2026). 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][15][16]
Ask the plan: DHHS Medicaid Medical Services (ServiceAuthorizationFFS@dhhs.nh.gov) or the member’s health plan.
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]
NH Medicaid’s General Billing Manual (Volume I, August 2026) sets the record rules for every provider. Records must be typed or legible, dated, identify the member, “Document the name of the performing provider,” and support medical necessity. Clinical records must “document each member encounter”, including the date of service, the procedures performed, the member’s progress and response to treatment, physician orders and the “Signature and title” of the provider. Billing records are kept at least six years from the date of service. The manual sets no deadline for signing a note. For FFS ABA, Form 272A must also be signed by the ABA provider, with a signed physician’s order and letter of medical necessity, and a paper CMS-1500 must be signed and dated in box 31 on or after the last date of service.[15][16][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]
No NH Medicaid document addresses it. The fee schedule lists 97153 and 97155 as separate lines with separate SA flags, and neither the General Billing Manual (Volume I, August 2026) nor the EPSDT provider manual (Volume II, August 2026), which has no ABA-specific section, says whether they may be billed for the same clock time. Ask before billing overlapping time.[5][15][16]
Ask the plan: NH Medicaid Provider Relations, (603) 223-4774 or (866) 291-1674 (FFS), or the member’s health plan for MCO members: ask whether 97155 may overlap 97153 for the same minutes.
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).
Yes. RSA 167:4-d makes NH Medicaid cover telehealth on the same basis as in-person care, from any site including the home, and names BACB-certified professionals and the staff they supervise among the providers who may use it. That covers the 97151 assessment and 97155 supervision when medically necessary. No NH document sets an ABA code list or POS, so confirm billing details with NH MMIS or the health plan.
Weekly. Fee-for-service payment is issued each week for claims adjudicated the previous week, with a weekly Remittance Advice. No submission cut-off time is published. MCO members follow their plan’s payment schedule.
No ABA code is on DHHS’s EVV service list (updated May 2026), which covers home health, personal care, private duty nursing and respite delivered in the home.
Rendering, ordering and referring providers must have an NPI on file and on the claim, and claims are processed by crosswalking the NPI and taxonomy to the Medicaid provider ID.
Twelve months from the earliest date of service for fee-for-service claims (He-W 521.04). MCO claims follow each plan’s contract; the three NH MCOs allow 120 days.
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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