MedicaidCoverageMedium impact
Updated Service Definition and Changes to Billing and Utilization of Applied Behavior Analysis Services
Nebraska Medicaid·NE · Psychiatry, Pediatrics·Prior Authorization
Effective date
Jul 1, 2026
We identified it
Jun 21, 2026
Summary
Nebraska Medicaid has updated Applied Behavior Analysis (ABA) service definitions and billing requirements effective July 1, 2026. Key changes include: ABA services in schools cannot be billed directly by independent providers (only through school-based services reimbursement), and individuals receiving waiver services from the Division of Developmental Disabilities may now receive ABA assessments regardless of age.
Action Required
By July 1, 2026: Stop billing Nebraska Medicaid directly for ABA services provided in school settings - these must go through school-based services reimbursement. Update billing systems to allow HCPCS codes 97151 and 97152 for ABA assessments for waiver recipients from Division of Developmental Disabilities regardless of age. Review updated ABA service definitions at the provided Nebraska Medicaid website and ensure all ABA billing meets the new requirements.