Reimbursement Update: CPT Code 97153 for ABA Therapy in DE, PA, and WV

Effective Oct. 16, 2026, Highmark will update reimbursement for CPT 97153 (Adaptive Behavior Treatment by Protocol) across applicable Commercial products in Delaware (DE), Pennsylvania (PA), and West Virginia (WV).

This reimbursement update is the result of a comprehensive review of Applied Behavior Analysis (ABA) therapy reimbursement levels, market trends, and evolving service delivery models. The revised rates are intended to maintain fair and competitive reimbursement for technician-delivered ABA services while aligning payment methodologies more closely with prevailing market practices.

Market Review and Rationale

CPT 97153 is typically used to report direct adaptive behavior treatment services delivered by a Registered Behavior Technician (RBT) or other qualified behavioral health technician under the supervision of a Board Certified Behavior Analyst (BCBA), physician, psychologist, or other qualified clinician.

As part of our review, Highmark evaluated:

• Reimbursement practices across commercial payers.
• The relationship between technician-delivered services and clinician-supervised ABA services.
• Current reimbursement levels across Highmark markets.
• Access to care and network sustainability considerations.
• The review found that reimbursement for CPT 97153 in several markets exceeded prevailing reimbursement relationships commonly observed between technician-delivered services and clinician-delivered services.

The reimbursement team conducted this assessment consistent with the applicable Non-Quantitative Treatment Limitation (NQTL) analysis and documented the related rationale, considerations, and supporting information specific to provider reimbursement.

The revised reimbursement structure is intended to:

• Better align reimbursement with technician-delivered service models.
• Promote reimbursement parity across markets and products.
• Maintain competitive reimbursement relative to market benchmarks.
• Support long-term sustainability of ABA services for members and providers.
• Preserve appropriate differentiation between services performed by behavioral health technicians and services delivered directly by BCBAs and other licensed clinicians.

Commitment to Autism Services

Highmark remains committed to ensuring members continue to have access to medically necessary ABA services and autism spectrum disorder treatment. This reimbursement update does not change:

• Member eligibility or benefits
• Medical necessity criteria
• Authorization requirements
• Coverage policies
• Documentation expectations

Providers should continue to bill services in accordance with applicable coding guidelines.

Updated Reimbursement Rates for CPT 97153