Iowa Medicaid ABA rates have not changed since July 2024: 97153 pays $17.16 at the technician tier and 97155 pays $36.81. Hawki still excludes ABA.
Key Takeaways
- Rates are frozen at 2024 levels: Every ABA code on Iowa Medicaid’s August 1, 2026 Behavioral Health fee schedule carries a July 1, 2024 effective date, the day a 5 percent legislative increase took effect.
- Both recent increases came from appropriations: Legislative funding raised ABA rates 8.9 percent in 2022 and 5 percent in 2024, and a 2025 bill to add ABA to Hawki passed the House 89 to 0 before stalling in the Senate.
- The schedule rewards analyst time: Code 97155 pays $36.81 per unit, about 2.1 times the technician rate for 97153 and trails only South Dakota’s $39.00 among Iowa’s neighbors.
- Coverage and coding are the next tests: Hawki does not cover ABA for the 678 children with an autism diagnosis that HHS identified in its claims data, and January’s CPT changes will require Iowa to remap its credential modifiers.
Iowa Medicaid pays for applied behavior analysis (ABA) on a fee schedule that has not changed in more than two years. Every adaptive behavior code on the Behavioral Health fee schedule dated August 1, 2026 carries an effective date of July 1, 2024, the day a 5 percent legislative increase took effect. CPT code 97153 pays $17.16 per 15-minute unit when a Registered Behavior Technician delivers it, and 97155 pays $36.81 when a Board Certified Behavior Analyst does.
Those rates place Iowa near the top of its region on analyst time and in the upper middle on technician time. The sharper gap is coverage. Children enrolled in Hawki, the state’s Children’s Health Insurance Program, have no ABA benefit, and a 2025 bill to add one passed the Iowa House 89 to 0 before stalling in the Senate.
How Iowa Medicaid Covers ABA Through IA Health Link
Most Iowa Medicaid members receive care through IA Health Link, the managed care program, which a September 2024 Legislative Services Agency brief said left fewer than 10 percent of members in fee-for-service. Three plans run it: Wellpoint Iowa, Iowa Total Care, and Molina Healthcare of Iowa. The informational letters that set ABA rates are addressed to both managed care and fee-for-service providers, but whether each plan’s contracted rates track the state schedule is not visible in public documents.
ABA is billed under Provider Type 62, Behavioral Health. When Iowa Medicaid announced its July 2024 increase in Informational Letter 2613-MC-FFS, it stated that the new rates applied only when the codes were billed by that provider type. The August 2026 psychologist fee schedule lists no adaptive behavior codes.
Iowa’s Medicaid rules set who may deliver the service. Licensed Behavior Analysts are eligible to participate. Licensed Assistant Behavior Analysts must work under a Licensed Behavior Analyst, and Registered Behavior Technicians must work under a licensed analyst or assistant analyst. Under a 2018 law, Iowa licenses behavior analysts through its Board of Behavioral Science, which grants the license on proof of current national board certification.
Iowa ABA Fee Schedule: Rates Set by Credential
Iowa prices ABA by the credential of the person delivering it, using three modifiers defined in Informational Letter 2431-MC-FFS: HP for doctoral-level Board Certified Behavior Analysts, HO for master’s-level analysts, and HN for assistant analysts, Registered Behavior Technicians, and non-certified support staff. That letter, effective April 1, 2023, also added 97155, 97157, and 97158 to the covered code set.
The tiers matter most on 97153. A technician billing under HN is paid $17.16 per unit, or $68.64 an hour. An analyst delivering the same direct treatment under HO or HP is paid $28.59, or $114.36 an hour. Iowa joins New Mexico, where the top credential tier earns nearly double the technician rate, and Delaware, which pays by degree, among states in this series that tie direct-treatment pay to the clinician’s credential.
Three other features stand out. Group treatment under 97154 pays exactly what one-on-one treatment pays: $17.16 at the technician tier and $28.59 at the analyst tier. Family adaptive behavior treatment guidance under 97156 carries a $17.16 technician rate alongside the $28.59 analyst rate. And on the two analyst group codes, 97157 and 97158, doctoral analysts receive $8.90 per unit against $8.39 for master’s-level analysts, the only ABA codes on which the schedule separates the two degrees. Assessment under 97151 pays $35.73.
Analyst treatment carries the largest premium. At $36.81 per unit, or $147.24 an hour, 97155 pays about 2.1 times the technician rate for 97153. That structure will need remapping in January, when the 2027 CPT revisions split 97155 and add six adaptive behavior codes.
How Iowa ABA Rates Reached $17.16
Both of Iowa’s ABA rate increases since 2022 trace to legislative appropriations. Iowa Department of Human Services rules implementing 2022 Iowa Acts, House File 2578, raised ABA rates 8.9 percent, and Iowa Medicaid’s July 2022 rate letter shows 97153 rising from $15.00 to $16.34 at the technician tier and from $25.00 to $27.23 at the analyst tier. Code 97155 entered the schedule at $35.06 in April 2023.
In 2024, House File 2698 appropriated $2,104,186 for rate increases to mental health providers, and Iowa Medicaid applied a 5 percent increase to ABA effective July 1, 2024. That produced the current $17.16, $28.59, and $36.81 rates. The state plan amendment notice posted in June 2024 listed the ABA increase alongside raises for physical therapists, occupational therapists, and community mental health centers. Nothing on the August 2026 schedule reflects a later ABA adjustment.
Iowa ABA Rates Compared to Neighboring States
Against its neighbors, Iowa sits in the upper middle on technician time and near the top on analyst time. These comparisons use published fee-for-service rates, which serve as a benchmark rather than a measure of what each managed care plan pays.
Medicaid 97153 (adaptive behavior treatment by protocol, technician-delivered), rate per 15-minute unit: Iowa and neighboring states. Iowa’s figure is its HN technician-tier rate. Source: MediRate.
On 97153, Iowa’s $17.16 trails South Dakota at $21.73 and Nebraska at $18.70 and runs ahead of Missouri at $16.37, Minnesota at $16.14, Illinois at $13.00, and Wisconsin at $11.91.
Medicaid 97155 (adaptive behavior treatment with protocol modification, analyst-delivered), rate per 15-minute unit: Iowa and neighboring states. Missouri publishes two 97155 rates: $27.46 carries the U8 home-setting modifier and applies to the Behavior Analyst and Psychologist tier. Source: MediRate.
On 97155 the gap widens. Iowa’s $36.81 trails only South Dakota’s $39.00 and runs $9.35 above Missouri’s in-home rate of $27.46 and 82 percent above Minnesota’s $20.17. Iowa’s rate also sits close to Hawaii’s $35.94. For granular rate detail across the full ABA code set, MediRate maintains the underlying data.
Hawki and the Autism Support Program Leave a Coverage Gap
Iowa’s sharper access question sits outside the Medicaid rate table. According to a December 2024 report required by House File 2402, Hawki covers uninsured children under 19 in families with incomes between 168 and 302 percent of the federal poverty level. In that report, the Department of Health and Human Services (HHS) told legislators that ABA is not a covered Hawki benefit unless a child uses the Autism Support Program, and, using fiscal 2023 claims, identified 678 Hawki children with an autism diagnosis.
The Autism Support Program is a narrow backstop. It pays for ABA for children under 14 who lack Medicaid or private coverage for the service, in households earning up to 500 percent of the poverty level, with a maximum annual benefit of $36,000 and up to 24 months of treatment. In a rule review dated September 1, 2026, HHS reported serving 14 children in state fiscal year 2024 and 16 in 2025.
House File 509 would have moved those children into Hawki. The bill would have directed rules adding ABA to the Hawki benefit, closed the Autism Support Program to new applicants after June 30, 2025, and repealed it on July 1, 2027. It passed the House 89 to 0 on March 20, 2025, and a Senate subcommittee recommended passage on April 1. The Legislature’s bill history, updated in August 2026, shows no further action. The fiscal note estimated the cost of adding ABA to Hawki at about $2.9 million a year, roughly $753,000 of it state money, assuming 18 percent of eligible children used the benefit at about $24,000 each per year, a figure drawn from Medicaid experience.
What Iowa ABA Providers Should Watch
The next appropriations bill. Both ABA increases since 2022 arrived through legislative appropriations, and the August 2026 fee schedule reflects no change since July 2024.
Whether Hawki legislation returns. House File 509 drew unanimous House support, and the program it would have replaced is still operating. In its September 2026 review, HHS proposed re-promulgating all seven Autism Support Program rules.
The 2027 code set. Iowa will need to decide how its HN, HO, and HP modifiers attach to the new adaptive behavior codes, particularly those replacing 97155, where its premium for analyst time is concentrated.
Federal guidance. CMS released a State Medicaid and CHIP ABA Toolkit on August 4, 2026, citing a 421 percent increase in Medicaid and CHIP ABA spending from 2021 to 2025. The agency said the toolkit does not restrict services, but it covers payment, enrollment, utilization management, and the diagnosis questions Acuity has examined, and states such as Indiana have already rewritten their benefits.
Frequently Asked Questions
What does Iowa Medicaid pay for ABA in 2026?
The Behavioral Health fee schedule dated August 1, 2026 pays $17.16 per 15-minute unit for 97153 at the technician tier (modifier HN) and $28.59 when an analyst delivers it (HO or HP). Code 97155 pays $36.81, 97156 pays $28.59 at the analyst tier, and 97151 pays $35.73. Every ABA code carries a July 1, 2024 effective date.
When did Iowa last raise ABA rates?
On July 1, 2024, when Iowa Medicaid applied a 5 percent increase funded by 2024 Iowa Acts, House File 2698. The previous increase, 8.9 percent, took effect July 1, 2022.
Does Iowa Medicaid pay ABA providers differently by credential?
Yes. Modifier HP marks doctoral-level analysts, HO master’s-level analysts, and HN assistant analysts, Registered Behavior Technicians, and non-certified support staff. Direct treatment under 97153 pays $17.16 at HN and $28.59 at HO or HP.
Does Hawki cover ABA?
No. HHS reported in December 2024 that ABA is not a covered Hawki benefit unless the child uses the Autism Support Program, which serves children under 14 in households earning up to 500 percent of the poverty level. House File 509, which would have added ABA to Hawki, passed the House in March 2025; the Legislature’s bill history shows no action after a Senate subcommittee recommended passage in April 2025.
Who can provide ABA under Iowa Medicaid?
Licensed Behavior Analysts may participate directly. Licensed Assistant Behavior Analysts must practice under a Licensed Behavior Analyst, and Registered Behavior Technicians must work under a licensed analyst or assistant analyst. Services are billed under Provider Type 62, Behavioral Health.
Sources: MediRate; Iowa Department of Health and Human Services, Iowa Medicaid Behavioral Health fee schedules (July 1, 2024 and August 1, 2026) and Psychologist fee schedule (August 1, 2026); Informational Letters 2431-MC-FFS (March 9, 2023) and 2613-MC-FFS (July 25, 2024); Iowa Medicaid ABA rate letter (August 12, 2022); Iowa Department of Human Services rulemaking implementing 2022 Iowa Acts, House File 2578; State Plan Amendment IA-24-0006 public notice (June 28, 2024); South Dakota Medicaid ABA fee schedule (effective July 1, 2026); Iowa Administrative Code 441-77.26, including subrule 77.26(10); Iowa Code chapter 154D; HHS, Hawki Program Benefits and ABA (December 2024); HHS Red Tape Review Rule Report, chapter 441-22 (September 1, 2026); Iowa Legislative Services Agency, fiscal note for House File 509 (March 19, 2025) and managed care issue review (September 2024); Iowa General Assembly bill history for House File 509; Centers for Medicare and Medicaid Services (August 4, 2026); prior Acuity Media Network reporting.
