ABA Maximum Allowed Amounts Starting May 1, 2025: What Providers Should Know

In the dynamic world of ABA therapy, keeping up with change isn’t just helpful—it’s essential. If you’re working with Tricare under the Autism Care Demonstration (ACD), you’ll want to circle May 1, 2025, on your calendar. That’s when Tricare will roll out updated Maximum Allowed Amounts tied to several critical CPT codes that directly impact your reimbursement.

This isn’t just another routine update—it could significantly shift how you bill, influence your clinic’s financial performance, and even affect how services are delivered to your clients. Whether you're a BCBA, BCaBA, or RBT, these changes matter.

Let’s take a closer look at what’s changing, why it matters, and what actions you should be considering now to ensure you’re not just reacting, but getting ahead.

Understanding ABA Maximum Allowed Amounts

In simple terms, the Maximum Allowed Amount is the highest rate Tricare will reimburse for a specific service. These rates are determined based on your credential (e.g., BCBA, BCaBA, RBT) and where your services are delivered.

The system isn't random. Tricare sets these rates through a careful process of:

• National Medicaid reference rates

• Medicare’s Geographic Practice Cost Indices (GPCI)

This helps ensure that providers in higher-cost areas—think Alaska or San Francisco—receive higher reimbursement compared to lower-cost regions. 

The result? A fairer playing field for ABA professionals across the country.

Which CPT Codes Are Affected?

There are four primary CPT codes that have been updated. Each of them is billed in 15-minute units, and they’re frequently used in day-to-day ABA services:

• 97151 – Behavior identification assessment

• 97153 – Adaptive behavior treatment by a technician

• 97155 – Protocol modification with behavior treatment

• 97156 – Family guidance for adaptive behavior

These are the workhorse codes of most ABA practices, so any change in their allowed rates has a direct impact on your billing operations. 

State-by-State Reimbursement Rates (Selected Highlights)

Here’s a quick overview of what’s new. We’ve highlighted a few examples from Tricare’s updated list. These rates show the reimbursement for each 15-minute unit of 97151 and 97153.

📌 These rates are only a sample. Be sure to check the full reimbursement table for your state or zip code region to get exact figures.

What Do These Changes Mean for You?

Let’s say you run a small ABA clinic in Phoenix, Arizona. The new rates mean your BCBAs will be reimbursed at a higher rate than before for assessments and technician services. On the other hand, if you operate in Arkansas or Alabama, the rates haven’t shifted much, but they’re still consistent and predictable.

Here’s how Tricare’s tiered system generally breaks down:

• BCBA-Ds / BCBAs: Highest tier reimbursement

• Assistant Behavior Analysts (BCaBAs): Mid-tier

• RBTs: Entry-level tier

If you’re managing a team, these tiers can help you plan caseloads, estimate monthly revenue, and determine how to balance staffing between direct care and supervision. Partnering with a reliable ABA billing company can also ensure your billing operations are aligned with these tiers to maximize reimbursement.

Don’t Overlook These Additional Codes

In addition to the primary CPT codes, Tricare has also updated rates for group sessions, care coordination, and other indirect services. These codes often apply to BCaBAs and BCBAs not delivering direct treatment.

These additional codes may not make up the bulk of your billing—but they still add up, especially if your team spends time coordinating care or hosting caregiver training. Ensuring your team’s ABA credentialing is up to date is also key to preventing delays in claim processing. It’s also important to ensure that all providers involved in these services maintain up-to-date ABA credentialing to avoid claim denials due to expired or missing enrollment information.

Actionable Steps for Providers

With the new rates going live on May 1, 2025, here’s what you should do to make sure your clinic doesn’t miss a beat:

Update Your Billing System

Take a moment to review and update your billing system and rate tables with the new amounts. Doing this now can help you prevent costly underpayments or rejected claims down the line.

Train Your Staff

It’s essential that every member of your team, from RBTs to billing specialists, fully comprehends:

✔️Which CPT codes to use

✔️How to properly document service times

✔️The differences between protocols, direct treatment, and supervision

Re-check Patient Coverage

Reach out to Tricare directly or log into your clearinghouse portal to confirm patient benefits. Make sure their coverage aligns with the updated CPT codes and reimbursement rates before you move forward with billing.

Audit Pending Claims

If you’ve got claims hanging out from April that spill into May, you may need to split the dates of service or adjust billing accordingly.

Nail the Documentation

Tricare is strict about billing in 15-minute increments. Make sure every session is backed by clean, accurate documentation—down to the start and stop times.

Let’s Look at the Numbers

Imagine a clinic in Anaheim, CA with:

3 BCBAs

2 Assistant Behavior Analysts

4 RBTs

Each staff member delivers an average of 30 hours/month under CPT 97153. Here’s a snapshot of how that would translate in revenue:

Role	Hourly Rate (97153)	Monthly Hours	Estimated Monthly Revenue
3 BCBAs	$31.25	90	$2,812.50
2 BCaBAs	$28.25	60	$1,695.00
4 RBTs	$20.27	120	$2,432.40
Total	–	270	$6,939.90

That’s nearly $7,000/month in one code alone. Add in the other codes—and rates—and the potential revenue jump becomes even more substantial.

Helpful Resources

Here’s where you can find more info and official updates:

📄 Full Tricare Rate Table – 2025

📘 Tricare ABA Billing Guidelines

🔍 Autism Care Demonstration Overview

Download our ABA billing guide to better understand CPT codes, documentation tips, and payer-specific requirements.

FAQ

1. What is the recommended amount of ABA therapy?

The ideal ABA therapy ranges from 10 to 40 hours weekly, with 25–40 hours recommended for young children to achieve meaningful progress in core developmental areas.

2. What is CPT code 97151 for ABA?

CPT code 97151 is used for behavior identification assessments conducted by a qualified professional, including observation, assessment, and plan development for ABA therapy services.

3. What happens if provider credentialing isn’t current?

If a provider's credentialing is outdated or incomplete, it can lead to claim denials, payment delays, or even audit risks. To avoid disruptions, verify that all staff credentials are current, accurately documented, and properly linked within your billing system. Regular audits and proactive updates can prevent costly setbacks.

Conclusion

This isn’t just a rate update—it’s an opportunity. By preparing early and educating your team, you’ll not only protect your revenue but also ensure your operations run smoother than ever.

When it comes to ABA billing, staying informed isn’t just smart—it’s what keeps the doors open.