MedicaidAdministrativeMedium impact
PT 76-26: Applied Behavior Analysis Referring Provider Requirements
Maryland Medicaid·MD · Psychiatry·Provider Transmittal
Effective date
Jul 1, 2026
We identified it
Jun 18, 2026
Summary
Starting July 1, 2026, Maryland Medicaid will require ABA providers to include the NPI of the referring practitioner in Field 17b on all claims and verify the referring provider is actively enrolled with Maryland Medicaid on the date of service. Claims will be denied if the referring practitioner is not actively enrolled or if a group/facility NPI is used instead of an individual practitioner NPI.
Action Required
By July 1, 2026: ABA billing team must update claims submission process to include individual referring practitioner NPI in Field 17b (not group/facility NPIs). Verify referring practitioner's active Maryland Medicaid enrollment status using the Provider Verification System before rendering services. Review ABA Provider Manual page 7 for qualified referring provider types. Claims will be denied without proper individual referring practitioner NPI and active enrollment verification.