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Revised Educational Requirements for Provisional Licensed Applied Behavior Analysis (ABA) Providers
Act
by Feb 1, 2026
Effective date
Feb 1, 2026
Identified
Jun 20, 2026
Summary
Effective February 1, 2026, provisional licensed behavior analysts and assistant behavior analysts in Missouri Medicaid (MO HealthNet) can only bill three specific procedure codes (97152, 97153, 97154) until they complete BACB-equivalent educational requirements. Claims for other ABA codes (97151, 0362T, 97155-97158, 0373T) submitted by non-compliant provisional licensees will be recouped.
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What to do
by Feb 1, 2026 · 5 steps
01Billing team must update billing software and fee schedules to restrict provisional licensed ABA providers (use modifiers HO for behavior analysts, HN for assistant behavior analysts) to ONLY CPT codes 97152, 97153, and 97154.
02Configure system to block or flag claims for CPT codes 97151, 0362T, 97155, 97156, 97157, 97158, and 0373T when submitted by provisional licensees without documented degree completion.
03Create verification process to confirm provider educational status in billing system before claim submission.
04Obtain and maintain documentation of degree completion dates from all provisional ABA providers and implement post-payment review protocol with MMAC.
05Notify all provisional licensed ABA providers of restrictions and requirements.
If missed: Failure to comply will result in recoupment of claims paid for restricted codes.
Codes mentioned
9715297153971549715197155971569715797158
Original notice
Revised Educational Requirements for Provisional Licensed Applied Behavior Analysis (ABA) Providers
mydss.mo.gov · Always check the source before changing claims.
Related changes
See all Missouri Medicaid (MO HealthNet) changes →Important Information for Documenting and Billing for Applied Behavior Analysis ServicesHighEffective Sep 9, 2026 · Provider NoticeBehavioral Health Services - Reminder on Maximum Quantity Changes Effective July 1, 2022HighEffective Jul 1, 2022 · Provider NoticeClarification for Provider Bulletin Volume 41 Number 32, dated December 28, 2018MediumEffective Jan 30, 2019 · Provider NoticeApplied Behavioral Health Analysis (ABA) Billing - System UpdateMediumEffective Oct 28, 2022 · Provider NoticeBrowse every Missouri Medicaid (MO HealthNet) change in the policy list