Washington’s 2026 Apple Health fee schedule pays ABA technicians near regional norms but sets the analyst 97155 rate far below Oregon and Nevada.
Key Takeaways
- Washington cut its Apple Health (Medicaid) applied behavior analysis fee schedule by 2 percent effective January 1, 2026, rolling back part of the increase it granted in 2024. The technician code 97153 now sits at $12.40 per 15-minute unit, roughly in line with neighboring states.
- The analyst code 97155, used for treatment with protocol modification, pays just $14.09 per 15-minute unit. That is barely above the technician rate and less than half of what Oregon ($32.07) and Nevada ($30.10) pay for the same code.
- Washington routes every ABA case through a Center of Excellence referral gate and a managed-care-dominant delivery system. Prior authorization is required for technician-delivered treatment but not for the analyst code.
- Providers weighing the Washington market should model the blended effect of a near-flat analyst rate against the state’s documented access waitlists, rather than reading either code in isolation.
Washington updated its Apple Health (Medicaid) fee schedule for applied behavior analysis effective January 1, 2026, and the revision touched nearly every line. The state Health Care Authority (HCA) marked the assessment, treatment, and group codes with a rate-update indicator, signaling that the dollar figures providers bill against were revised with the new year. The schedule does not print the direction or size of each change on its face, but HCA’s separate managed care rate-reduction guidance does: effective January 1, 2026, the agency lowered the fee-for-service ABA rates by 2 percent, rolling back part of the increase it granted in 2024 to help meet a budget-directed cut in managed care spending.
The headline is not the size of any single change. It is the gap between two codes that, in most states, move together. Washington pays 97153, the adaptive behavior treatment code delivered by a certified behavior technician, at $12.40 per 15-minute unit. It pays 97155, the protocol-modification code delivered by an analyst, at $14.09. The analyst rate sits about 14 percent above the technician rate, a spread that looks nothing like the one next door in Oregon, where the same analyst code pays more than double the technician code.
Washington raised most ABA codes by 15 percent and two specialized codes by 20 percent in January 2024, funded through the 2023 to 2025 operating budget and backed by a state-directed payment requiring managed care plans to pay at least the fee-for-service floor. The 2026 schedule then trimmed all of those rates by 2 percent. That history matters for context: the compression between analyst protocol modification and technician treatment predates 2026, so the 2026 cut lowered both codes rather than introducing the compression for the first time.
The update also lands in a tense national moment for the therapy. States including North Carolina, Nebraska, Colorado, and Indiana have moved to cut ABA payments or tighten authorization, and a series of federal and state audits has flagged improper billing, developments documented in national reporting and by provider groups such as the Council of Autism Service Providers. That pressure has already fed behavioral health layoffs and provider exits in several markets, which makes a state’s rate structure a competitive variable, not just a billing detail.
Apple Health covers ABA for clients with autism spectrum disorder or another developmental or intellectual disability for which the therapy has evidence, and only when less intensive treatment has not succeeded. That medical-necessity framing, paired with the Center of Excellence gate described below, means the rate schedule governs a tightly controlled benefit rather than an open one, and it puts a premium on the analyst time that documents and modifies each plan of care.
What Washington’s 2026 Apple Health ABA Fee Schedule Pays
At the assessment end, HCA pays $18.79 per unit for 97151 (behavior identification assessment) and reserves a higher $58.80 unit for 0362T, the supporting assessment used in customized settings for clients with destructive behaviors. On the treatment side, the technician code 97153 pays $12.40 and requires prior authorization, while the analyst code 97155 pays $14.09 and does not. Family guidance (97156) pays $18.32, group codes step down by headcount, and the intensive day-treatment program bills a single per diem (H2020) of $582.96.
The schedule sits inside a tightly defined service model. An analyst must supervise at least 5 percent of the technician’s direct care each week, roughly one hour for every twenty, and the program reserves the technician treatment code for hands-on delivery while the analyst code covers protocol modification. The schedule also draws a clear telemedicine line: HCA allows the analyst code (97155) and the caregiver-guidance codes to be delivered by telemedicine, but not the technician treatment code (97153), which must be in person.
Rounding out the schedule are a specialized treatment code, 0373T, set at $24.11 for protocol modification delivered in a customized environment for clients with destructive behaviors, and a tiered set of group codes that step down as the group grows, from two clients to six or more. Those codes confirm that the fee schedule is built around individual, in-person treatment as the default, with group and customized-setting work treated as the exception rather than the model.
Against its neighbors, Washington’s technician rate is unremarkable.
Medicaid 97153 (adaptive behavior treatment by a technician), maximum allowable rate per 15-minute unit: Washington and selected Western states. Source: MediRate.
On 97153, the four states cluster within a few dollars, from Montana’s $11.36 to Oregon’s $14.70, with Washington’s $12.40 sitting comfortably inside the band, according to MediRate’s comparison. Larger neighbors are mid-transition, which could reset the picture: California’s pending rate-setting SPA may move its own ABA payments later in the year.
Why the 97155 Analyst Rate Stands Out
The picture inverts on 97155.
Medicaid 97155 (adaptive behavior treatment with protocol modification, analyst-delivered), maximum allowable rate per 15-minute unit: Washington and selected Western states. Source: MediRate.
Here Washington separates from the region. Where Oregon pays $32.07 and Nevada roughly $30 for analyst-delivered protocol modification, Washington pays $14.09, according to MediRate. In Washington’s billing guide, 97155 is the code an analyst uses for treatment with protocol modification. It does not require prior authorization, and HCA’s billing guide lists it as analyst-delivered time requiring lead analyst involvement. The effect is that an analyst’s modification work is reimbursed at close to what a technician earns for direct treatment, even though the credential and training requirements differ sharply.
HCA does not publish a rationale for setting the analyst code so close to the technician rate, so the contrast is documented while its cause is not. Other states have taken sharply different approaches to analyst and supervision time: Vermont’s January 2026 billing overhaul, for instance, restructured how concurrent analyst work is paid. Washington’s schedule simply lists 97155 just above 97153 and moves on, which means a provider’s blended rate depends heavily on the mix of technician and analyst hours in a given plan of care. A clinic that leans on senior analysts for direct modification work absorbs that compression most directly.
Access in Washington: Referral Gates, Prior Authorization, and Waitlists
Rates are only half of the access equation. Washington routes every ABA case through a Center of Excellence, which must complete a comprehensive evaluation and write the order before services begin. For clients diagnosed with autism at 21 or older, that evaluation must come from a neurologist, psychiatrist, or psychologist, or an HCA-designated nurse practitioner or general practitioner. From there the pathway runs in three stages: referral and evaluation, selection of an enrolled ABA provider, and delivery of services once prior authorization is approved. Most Apple Health enrollees receive services through a managed care organization, each of which can layer its own authorization rules on top of the state’s.
Supply does not keep pace with demand. HCA’s own family-facing guidance notes that it is common for providers to keep waitlists, and advises families to get on several at once; the fee-for-service provider directory maintained for the program flags agencies that are not accepting new clients. The intensive day-treatment track, capped at 48 service days across about twelve weeks at a one-to-one adult-to-child ratio and typically authorized once in a client’s lifetime, is similarly rationed. These are the practical limits families hit even where a rate looks adequate on paper.
Those frictions sit against a tightening budget. Washington has closed new enrollment in its state-funded Apple Health Expansion program and is bracing for the coverage effects of federal Medicaid reductions, the kind of pressure that has pushed prior authorization to a 2026 flashpoint across behavioral health. In a market where the binding constraint is often the analyst workforce rather than the technician pool, a 97155 rate near the technician floor is the variable most likely to shape whether clinics can staff and retain the senior clinicians the model depends on.
Whether Washington follows neighbors like Nevada, which raised its ABA rates as spending surged, and Utah, which locked in a permanent rate-increase mechanism, or holds its current structure, will shape how it competes for that workforce. For now, the 2026 schedule pays Washington technicians in line with the region and its analysts well below it.
