Wyoming Medicaid covers applied behavior analysis for children with autism through EPSDT. The state plan, as amended by TN 24-0005 (approved October 31, 2024, effective July 1, 2024), moved ABA out of rehabilitative mental health services and into Preventive Services, cross-referenced from expanded EPSDT: "Applied Behavior Analysis (ABA) treatments are allowable to children between the ages of 0-20 years of age with a diagnosis of Autism Spectrum Disorder." The operating rules are in chapter 12.7 of the CMS-1500 provider manual (version 20.0, effective October 1, 2026).
Wyoming is simpler than most states in one respect: there are no Medicaid health plans to contract with. Every Wyoming Medicaid ABA claim goes to the state’s fee-for-service system. The only managed care entity in Wyoming Medicaid is the Care Management Entity run by Magellan for high-fidelity wraparound, which does not authorize or pay for ABA. The harder parts are a visit threshold that turns into prior authorization within weeks for a full-time ABA case, low rates, and a state behavior-analyst license that every BCBA needs.
The state plan lists ABA among the expanded EPSDT services "available to treat conditions detected in children and young adults under the age of 21," and says of all of them: "A prior authorization process will determine the medical necessity and most cost effective setting for the service," and limits "are not applicable to EPSDT recipients if the service is determined to be medically necessary as a result of an EPSDT referral and is prior authorized." The ABA page itself names the covered services (behavior identification assessment, supporting assessment, adaptive behavior treatment, family treatment guidance) and the practitioners: BCBA-D and BCBA, with BCaBAs and RBTs covered "when they are supervised by" one of them.[6][7][1][8][9]
There is no managed care layer to navigate. The provider manual routes ABA claims to Wyoming Medicaid directly, and its prior-authorization table lists Magellan Healthcare only for "Care Management Entity (CME) services," namely family care coordination, family and youth peer support, youth and family training and support, and respite. The state’s 1915(b) waiver describes the CME as a single prepaid ambulatory health plan for high-fidelity wraparound serving Medicaid youth with complex behavioral health needs (Magellan’s materials put eligibility at ages 4 to 20). A child can be in wraparound and receive ABA at the same time, but the ABA is billed to Wyoming Medicaid, not Magellan.[6][7][1][8][9]
Wyoming Medicaid does not require prior authorization before ABA starts. The downloadable fee schedule (run date October 1, 2026) carries a PRIOR_AUTH flag on about 1,450 code lines; none of 97151–97158, 0362T or 0373T is flagged. The catch is the behavioral-health service threshold in manual section 6.7. Codes 97151–97158 sit in the threshold code list alongside psychotherapy and therapy codes, "all modalities on same date of service count as 1 visit," and from 2021 dates of service the threshold "applies to all Members," under-21s included. Section 12.8.1: "For Medicaid Members with dates of service in excess of thirty (30) per calendar year, a prior authorization is required, which can be obtained through Telligen." A child in ABA four or five days a week reaches 30 dates in six to eight weeks, so request the Telligen authorization before then. Visits with different treating providers on the same day count separately.[1][4][6][2][3]
Telligen (833-610-1057) wants a clinical assessment, the most recent treatment plan ("must be reviewed every 90 days"), and progress notes showing movement toward the plan’s goals. Requests should arrive before the dates of service; "Any requests to Telligen that are for dates of service which are past timely filing will not be reviewed." An administrative denial can be reconsidered if new information arrives "within thirty (30) days of the denial"; after a reconsideration upholds a denial, the provider appeals to the state by email to the Utilization Management Coordinator, citing the Telligen reference number. One wrinkle: the threshold section’s template language describes services as "rehabilitative in nature," written for adult behavioral health; ABA has been an EPSDT preventive service since July 2024, so frame requests around EPSDT medical necessity.[1][4][6][2][3]
Telligen’s own Utilization Management Provider Manual (Version 5, 04/01/2026) sets the clock for "Outpatient Behavioral Health services over the threshold limits": submission "Prior to meeting the Threshold is preferred," services "provided after the threshold limit has been reached but prior to receiving an authorization are provided at the provider’s risk," and the review turnaround is "3 Business Days from Submission" (expedited requests: 1 business day). If the information is insufficient Telligen suspends the case and asks for records; with no answer in three business days it sends a reminder, and after three more it issues a technical denial. Once the records arrive the review finishes within 1–3 business days. A peer-to-peer may be requested within 14 calendar days of a medical-necessity denial, and a reconsideration within 30 calendar days of the denial letter. Since September 15, 2026, Qualitrac has an ABA option: submit new cases with Review Type "Behavioral Health Outpatient" and Type of Service "Applied Behavioral Analysis Therapy."[1][4][6][2][3]
Rates rose on July 1, 2026. A provider bulletin (deployed August 7, 2026, reprinted in the manual’s notifications log) gives 97153 by an RBT moving from $10.25 to $12.30 and 97155 by a BCBA from $20.50 to $24.60 per 15-minute unit, and the October 1, 2026 fee schedule shows the full set: 97151 $24.60; 97152 $12.30; 97153 $12.30; 97154 $4.04; 97155 $24.60; 97156 $24.60; 97157 $8.20; 97158 $9.31; 0362T $12.30; 0373T $12.30. The schedule also carries price rows for ages 21 and over and separate, higher rows for 97151–97153 under the four developmental-disability waiver benefit plans ($32.27, $20.56 and $19.23); the state plan and manual limit the EPSDT ABA benefit itself to ages 0–20. ABA is billed only with CPT codes: the manual’s ABA code table (12.7.2) lists 97151–97158, 0362T and 0373T and no HCPCS H-code. H0031 (mental health assessment), H2019 (therapeutic behavioral services) and H2014 (skills training) do sit on the fee schedule, but as other behavioral-health services, not ABA.[4][5][1]
The same bulletin settles a billing question that drives the revenue model: "The appropriate CPT code is determined by the service being performed, not solely by the credentials of the rendering provider." A BCBA delivering routine treatment from an established protocol bills 97153; 97155 "should be billed only when a BCBA or other qualified healthcare professional is actively assessing, modifying, or adapting the treatment protocol during a face-to-face session." The manual adds that indirect work (goal writing, data analysis, care coordination, staff training without the patient) is bundled, and "The only code that can be billed for indirect services is 97151."[4][5][1]
The manual’s ABA provider table requires BACB credentials at every tier: BCBA-D or BCBA (taxonomy 103K00000X), BCaBA (106E00000X) and RBT (106S00000X). BCBAs enroll "as an individual or in" a Board Certified Behavior Analyst group; BCaBAs and RBTs enroll only in a BCBA group. Since October 1, 2026 the assessment code 97151 is BCBA or BCBA-D only, and supervision "by a QHP/BCBA is required (approximately 1-2 hours per 10 hours of direct care by the technician)," raised from one hour per ten in this version of the manual. The supervision is bundled into the technician codes; when the BCBA is face-to-face directing the technician and modifying the protocol, that time is billed as 97155.[1][10][11][12][13][14][15]
Wyoming is a licensure state. Wyoming licenses behavior analysts. Since 2022 (HB0110, Enrolled Act 18) the State Board of Psychology "shall issue a license as a behavior analyst or an assistant behavior analyst" to an applicant who "holds a current certification as a board certified behavior analyst" (or BCaBA) verified with the certifying entity (W.S. 33-27-124(a)); the Board’s rules name "The BACB" as "the sole certifying entity recognized by the Board" and require BACB verification, license verification from every other state, proof of lawful presence and fingerprint cards (Rules ch. 4, § 4-3). A licensed assistant behavior analyst practices "only under the supervision of a licensed behavior analyst or licensed psychologist" (33-27-124(c)); the Board’s rule requires that supervision to be "at least two percent (2%) of the total behavior-analytic service hours provided per month," with at least one meeting a month (Board Rules ch. 14, § 14-5). Behavior technicians are not licensed: 33-27-125(a)(viii) exempts a technician "under the supervision of a licensed behavior analyst or licensed assistant behavior analyst," who may not design assessment or intervention plans, and (ix) exempts a caregiver working under that analyst’s direction. Representing yourself as a behavior analyst and practicing without a license or an exemption is a misdemeanor (33-27-119(b)). For a BCBA licensed in another state there is no shortcut written down for behavior analysts: 33-27-124(b) lets the Board license someone "currently licensed as a behavior analyst … in good standing in another jurisdiction that has licensure requirements comparable to" Wyoming’s, but that is still a Wyoming license, and the Board’s temporary 30-day license (Rules ch. 3, § 3-1) is written only for psychologists. Payers add their own floor: Wyoming Medicaid says a telehealth provider "must be licensed by, or otherwise under the jurisdiction of, the appropriate State of Wyoming licensing board," and BCBSWY says telemedicine providers "must be licensed in Wyoming." Plan on a Wyoming license for any BCBA treating a Wyoming child, including by telehealth. Credentialing has a state clock: under W.S. 26-56-102 a carrier must acknowledge an application within 7 calendar days, flag an incomplete one within 30, and "conclude the process of credentialing … within sixty (60) calendar days," and once you are credentialed with a contract in effect it must pay covered services "beginning with the date the health carrier received a completed credentialing application." Commercial ABA rates are negotiated and unpublished; the only public benchmark is the Wyoming Medicaid fee schedule (97153 $12.30 and 97155 $24.60 per 15-minute unit from July 1, 2026).[1][10][11][12][13][14][15]
Timely filing is 12 months: "The Provider must submit a clean claim to Medicaid within 12 months (365 days) of the date of service," with six months from a retroactive-eligibility determination, and timely filing "will not be waived when a claim is denied due to Provider billing errors or involving third party liability." Wyoming publishes no shorter payment promise of its own; federal rule requires the state to pay 90% of clean practitioner claims within 30 days of receipt and 99% within 90 days. Span billing is not allowed for behavioral health: each date of service goes on its own line. Corrections run on two clocks: "Providers may resubmit any denied claim or line within 12 months (365 days) of the date of service" and "may adjust any paid claim within six (6) months (180 days) of the date of payment" (adjustments that lower the payment have no limit; a denied claim cannot be adjusted, only resubmitted). Medicare crossovers get 12 months from the date of service or 6 months from the Medicare EOMB, whichever is later. Claims are processed weekly: "After claims have been processed weekly, Medicaid posts a Medicaid proprietary (paper) Remittance Advice (RA) to the Provider Portal," and the manual says to check claim status with Provider Services if payment has not arrived within 30 days of submission. No submission cut-off day or time is published.[1][16]
Every enrolled clinician is a rendering provider. "Those Provider types able to enroll with Wyoming Medicaid, even if working under the supervision of another practitioner, must enroll and be noted on the claim as the rendering Provider," with the individual NPI and taxonomy in box 24J, so an RBT’s 97153 line carries the RBT’s own NPI under the BCBA group. Telehealth uses the same codes and rates with modifier GT or 95, real-time audio and video only. Referring provider: the manual says Wyoming Medicaid "requires that ordering, referring, or prescribing (ORP) Providers be documented on claims" and that "All ORP Providers and attending Providers must be enrolled with Wyoming Medicaid," in-state or out; its CMS-1500 table marks box 17b ("the NPI number of the referring, ordering, or supervising Provider") as required while box 17 (name) is not. BCBA, BCaBA and RBT taxonomies are not on its list of taxonomies "Always Required to Include a Referring, Attending, Prescribing or Ordering (RAPO) NPI," so if a physician or psychologist referred the child, put that clinician’s NPI in 17b and confirm they are enrolled with Wyoming Medicaid. The manual does not mention electronic visit verification anywhere. Claim appeals go to Provider Services, (888) 996-6223, on the First Level Appeal and Grievance Request Form, and a second-level form exists for disputing that decision.[1][16]
The questions that decide whether a family can start with Wyoming Medicaid, and what they have to bring. Each maps onto something intake should ask on the first call.
Ages 0 through 20: ABA is "allowable to children between the ages of zero (0) to 20 years of age with a diagnosis of Autism Spectrum Disorder" (manual 12.7; state plan TN 24-0005). The fee schedule carries 21+ price rows, but the ABA benefit as written stops at 20.[1][6][4]
The manual’s ABA chapter names no referral or order requirement. ABA sits in the state plan’s Preventive Services section (TN 24-0005), and federal rule defines preventive services as services "recommended by a physician or other licensed practitioner of the healing arts," so keep a written recommendation on file.[1][6][18]
Allowed for enrolled BCBAs, who are on the manual’s list of distant-site practitioners. Telehealth must be "real time interactive audio and video"; telephone-only does not count. "The same procedure codes and rates apply as for services delivered in person," billed with modifier GT or 95. The child’s home can be the originating site with consent (verbal, email or text, documented), but no originating-site fee is paid when the family uses its own device. The provider "must be licensed by, or otherwise under the jurisdiction of, the appropriate State of Wyoming licensing board." No ABA-specific telehealth code list is published. The manual names no telehealth place-of-service code for practitioners (POS 02 is assigned only to Care Management Entity providers, who must not use GT/95), and neither it nor Telligen’s manual says the authorization must flag telehealth.[1][2]
Telligen’s provider manual (Version 5, 04/01/2026) gives "3 Business Days from Submission" for outpatient behavioral health requests over the threshold, which is where ABA sits, and 1 business day for expedited requests; an incomplete request is suspended for records and technically denied if they do not arrive within two 3-business-day windows. Submit before the child reaches 30 visits: services after the threshold and before the authorization "are provided at the provider’s risk." The federal fee-for-service ceiling also applies: since January 1, 2026 a standard request must be decided "in no case later than 7 calendar days after receiving the request" and an expedited one "in no case later than 72 hours." An administrative denial can be reconsidered with information sent within 30 days of the denial; after that it becomes a new request.[2][17][1]
"Medicaid is the payer of last resort. It is a secondary payer to all other payment sources and programs and should be billed only after payment or denial has been received from such carriers." Wyoming Medicaid pays "the lesser of the patient liability (deductible, coinsurance, and copayment) and the Medicaid allowed amount minus the other insurance payment amount," and CMS-1500 claims apply other insurance at the line level with adjustment reason codes. Timely filing is not waived for claims involving third-party liability.[1][19]
No diagnosis recency rule appears in the manual’s ABA chapter or the state plan. The dated requirement is the treatment plan, which Telligen expects "reviewed every 90 days" once the threshold is passed.[1][6]
Blocked on: Telligen utilization management, (833) 610-1057, or Wyoming Medicaid Provider Services, (888) 996-6223: ask whether an initial or threshold ABA request needs a diagnostic evaluation of a certain age.
Neither the manual nor the state plan names who may make the ASD diagnosis. Note that Wyoming’s licensure statute excludes "the diagnosis of psychological disorders" from the practice of behavior analysis (W.S. 33-27-113(a)(xiii)), so a BCBA’s assessment is not the diagnosis.[1][6][10]
Blocked on: Wyoming Medicaid Provider Services, (888) 996-6223, or Telligen, (833) 610-1057.
Coverage decides whether Wyoming 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.
Supervision "by a QHP/BCBA is required (approximately 1-2 hours per 10 hours of direct care by the technician)" (manual 12.7.3, raised from 1 hour per 10 on 10/01/2026). It is bundled into the technician codes; face-to-face direction with protocol modification is billed as 97155. BCaBAs and RBTs are covered when supervised by a BCBA-D or BCBA (state plan). Wyoming Board rules separately require BCaBA supervision of at least 2% of monthly service hours.[1][6][12]
Allowed for 97153 with 97155 only. Behavioral health documentation must show "No overlapping behavioral health services, except for codes 97153 and 97155" (manual 12.9.2); any other overlapping behavioral health services for the same member and time cannot be billed.[1]
The manual’s ABA code table sets daily maximums: 97151, 32 units (per NCCI MUE); 97153, 32; 97154, 32; 97155, 16; 97156, 4; 97157, 4; 97158, 32. No daily maximum is printed for 97152, 0362T or 0373T. Separately, 97151–97158 count toward the 30-visit-per-calendar-year behavioral-health threshold, beyond which Telligen PA is required.[1]
Entries "shall be signed and dated by the qualified staff member providing service," with "Full signature, including licensure or certification of the treating Provider"; providers "shall not sign for a service prior to the service being completed." Progress notes are required "for every contact billed to Medicaid" with start and end times, and all documentation and signatures must be complete "before or at the time the Provider submits a claim"; documentation completed afterwards is "insufficient to substantiate the claim."[1]
Not covered: "Diagnosis or treatment in a school-based setting by a Provider employed by the school district" (manual 12.8). No other ABA setting restriction appears in the manual; the state plan allows services "in a facility, a home or other setting." Telehealth to the home is allowed with the member’s consent.[1][6]
The rendering clinician’s own NPI. Provider types that can enroll "must enroll and be noted on the claim as the rendering Provider" even when supervised (manual 9.2), with the individual NPI and taxonomy in box 24J. BCBAs enroll individually or in a BCBA group; BCaBAs (106E00000X) and RBTs (106S00000X) enroll in a BCBA group, so the group is pay-to and the RBT or BCaBA is rendering on technician lines.[1]
Yes, for children ages 0 through 20 with an autism spectrum disorder diagnosis, as an EPSDT benefit under the state plan (TN 24-0005, effective July 1, 2024).
No. Wyoming Medicaid pays ABA fee-for-service. The only managed care entity is Magellan’s Care Management Entity, which runs high-fidelity wraparound (care coordination, peer support, respite) and does not cover ABA.
Not up front: no ABA code is flagged for PA on the fee schedule. But ABA codes 97151–97158 count toward a 30-visit-per-calendar-year behavioral-health threshold, and beyond 30 dates of service a prior authorization from Telligen is required. A full-time ABA case hits that within weeks, so plan the Telligen request early.
From July 1, 2026, per 15-minute unit: 97151, 97155 and 97156 $24.60; 97152, 97153, 0362T and 0373T $12.30; 97154 $4.04; 97157 $8.20; 97158 $9.31.
Not without a Wyoming license. Wyoming licenses behavior analysts (W.S. 33-27-124), and Wyoming Medicaid requires telehealth providers to be licensed by or under the jurisdiction of the appropriate Wyoming board, as well as enrolled with Wyoming Medicaid. The Board can license someone already licensed in a comparable state, but there is no temporary behavior-analyst permit in its rules.
No. ABA is billed with CPT 97151–97158, 0362T and 0373T, the only codes in the manual’s ABA code table. H0031, H2019 and H2014 appear on the fee schedule for other behavioral-health services.
Telligen’s provider manual gives 3 business days from submission for outpatient behavioral health requests over the 30-visit threshold (1 business day if expedited). Submit before the child reaches 30 visits: services after the threshold and before the authorization are at the provider’s risk.
The manual requires ordering, referring or prescribing providers to be documented on claims and enrolled with Wyoming Medicaid, and marks box 17b (their NPI) as required. ABA taxonomies are not on the list that must always carry one, so if a physician or psychologist referred the child, list that clinician in 17b and make sure they are enrolled.
Yes. Wyoming Medicaid bars overlapping behavioral health services "except for codes 97153 and 97155," so a BCBA directing a technician with protocol modification can bill 97155 while the RBT bills 97153.
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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