Maryland ABA Billing Guidelines

A Provider’s Guide to Compliant and Accurate ABA Billing in Maryland

Billing for Applied Behavior Analysis (ABA) services is complex by nature, but when you’re a provider in Maryland, compliance with state-specific guidelines becomes even more critical. From Medicaid policies to commercial insurance protocols, understanding and applying the correct Maryland ABA billing guidelines is essential for proper reimbursement, audit protection, and practice growth.

In this post, we’ll break down the core billing rules, coding details, documentation expectations, and payer nuances that every Maryland-based ABA provider needs to know.

What Are ABA Billing Guidelines?

ABA billing guidelines are payer-enforced policies that define how services like assessments, direct therapy, supervision, and family training should be coded, billed, and documented. These guidelines ensure consistency, accuracy, and compliance across the industry — and they’re especially important in a state like Maryland with both Medicaid and Managed Care payer involvement.

Related: Maryland ABA Billing Procedures

Core Maryland ABA Billing Guidelines (By Service Type)

✅ 97151 – Initial Assessment

Description: Assessment by behavior analyst to create treatment plan
Documentation: Must include measurable goals, assessment tools, and clinical justification
Limits: Often requires prior authorization and is time-limited (e.g., 8–10 hours)

✅ 97153 – Adaptive Behavior Treatment by Technician

Billed in 15-minute units
Requires direct supervision under 97155
Modifiers (e.g., HM, GO) vary by payer and must be accurately applied

✅ 97155 – Supervision and Protocol Modification

Delivered by a BCBA or licensed behavior analyst
Should reflect clinical observation or program modification, not just admin oversight

✅ 97156 – Family/Caregiver Training

Cannot occur simultaneously with direct therapy
Must document caregiver participation and clinical objective

✅ 0362T – Multiple Staff, Intensive Services

Requires 2+ staff and direct BCBA involvement
Used in higher-acuity or intensive settings
Often subject to authorization reviews and limits

Need coding support? Check out our Maryland ABA Billing Software Guide

Important Maryland Medicaid-Specific Guidelines

If you bill Medicaid or work with Medicaid MCOs (e.g., Aetna Better Health, MDWise, Priority Partners), follow these Maryland-specific requirements:

Pre-authorization is required for nearly all services
Submit initial treatment plans with measurable goals
Include progress updates and re-authorizations every 6 months
Track session attendance, missed visits, and parent participation
Maintain secure digital records of assessments and notes

You can review official policies via the Maryland Medicaid ABA Program site

Documentation Requirements

ABA billing isn’t just about codes — it’s about supporting each claim with defensible documentation. Your system must log:

Start/end times for each service
Provider credentials (e.g., RBT, BCBA)
Place of service and modality (e.g., home, telehealth)
Clinical objectives, patient behavior notes, and interventions used

Missing even one of these details could result in denials or audit flags.

Common Billing Mistakes to Avoid

Even experienced providers can fall into traps when billing ABA services in Maryland. Here are the most common errors:

🚫 Billing 97153 without supervision logs for 97155
🚫 Submitting overlapping sessions (e.g., tech and BCBA services billed at the same time)
🚫 Forgetting to update expired authorizations
🚫 Using incorrect or missing modifiers
🚫 Billing 97156 during the same time slot as 97153

Tips for Staying Compliant with the Maryland ABA Billing Guidelines

Use billing software that supports ABA-specific code logic
Set authorization alerts to avoid lapses
Create checklists for daily and weekly documentation reviews
Train your team on state billing updates every quarter
Work with a billing partner that specializes in behavioral health

Related: Maryland ABA Billing Services