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Reimbursement Update: CPT Code 97153 for ABA Therapy in DE, PA, and WV
Act
by Oct 16, 2026
Effective date
Oct 16, 2026
Identified
Aug 18, 2026
Summary
Effective October 16, 2026, Highmark is reducing reimbursement rates for CPT code 97153 (Adaptive Behavior Treatment by Protocol) across Commercial PPO products in Delaware, Pennsylvania, and West Virginia. Rates are being decreased to align technician-delivered ABA services with market benchmarks and maintain appropriate differentiation from clinician-delivered services. No changes to member eligibility, medical necessity criteria, authorization requirements, or coverage policies.
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What to do
by Oct 16, 2026 · 5 steps
01Billing team must update fee schedules in the billing system for CPT 97153 with new Highmark Commercial PPO rates—Pennsylvania Office: $16.59, Pennsylvania Non-Office: $15.73, West Virginia Office: $14.53, West Virginia Non-Office: $13.78, Delaware Office: $15.73, Delaware Non-Office: $15.73.
02Update provider fee schedules and billing system rate tables immediately upon publication to ensure claims are processed with correct rates on the effective date.
03Verify rates are applied only to Highmark Commercial products in DE, PA, and WV.
04Claims submitted with outdated rates after October 16, 2026 may be subject to adjustment or denial.
05No changes to coding, prior authorization, or medical necessity documentation are required.
Codes mentioned
97153
Original notice
Reimbursement Update: CPT Code 97153 for ABA Therapy in DE, PA, and WV
providers.highmark.com · Always check the source before changing claims.