MedicaidCoverageHigh impact
Guidance on the Continuation of Telehealth for ABA Services
Maryland Medicaid·MD·Provider Transmittal
Effective date
Nov 1, 2021
We identified it
Jun 20, 2026
Summary
Effective November 1, 2021, Maryland Medicaid will no longer reimburse for telehealth delivery of eight specific ABA procedure codes (97151, 97152, 97153, 97154, 97158, H2012, 0362T, 0373T). However, three codes (97155, 97156/97156-U2, 97157) will continue to be reimbursed via telehealth when billed with GT modifier and Place of Service 11.
Action Required
By October 31, 2021: Billing team must immediately update billing system rules to deny telehealth reimbursement for codes 97151, 97152, 97153, 97154, 97158, H2012, 0362T, and 0373T effective November 1, 2021. Configure system to require in-person delivery for these codes or apply appropriate modifiers for in-person services. Concurrently, ensure codes 97155, 97156, 97156-U2, and 97157 continue to process with GT modifier and Place of Service 11 for telehealth claims. Notify all ABA providers of this change and train billing staff on the new requirements. Claims submitted with telehealth modifiers for the eight discontinued codes will be denied by Maryland Medicaid.