Maryland’s ABA Billing: Support for Medicaid and Optum Providers

Maryland’s ABA Billing can be a complex maze, but we can make it easy to navigate. Whether you’re a solo BCBA or a large ABA practice, understanding Medicaid requirements and proper billing is essential to ensuring timely reimbursement and compliance.

At Taylor Prime Solutions, we specialize in full-service ABA billing support. Our team has deep experience with Maryland Medicaid, Optum policy updates, and ABA-specific CPT codes, modifiers, and documentation. We go beyond basic claims submission—we partner with you to maximize your reimbursement and minimize delays.

Resources for Providers

Visit Optum Maryland Provider Training & Education for:

ABA billing training videos
Incedo Provider Portal guides
Accessing ABA services documentation
Provider portal login
Clinical confirmation and treatment plan requirements

Please note: This blog post does not replace the official Billing Appendix or provider training from Optum Maryland. It serves as a companion resource and summary of frequently asked questions to help you stay on track.

Key Billing Insights ABA Providers Should Know:

Use the rendering provider’s NPI when submitting claims.
Service location codes include school (03), office (11), and home/community (12).
Modifiers like GT (telehealth) and U2 (child present during parent training) are critical for accurate billing.
Each billed service requires a detailed session note that matches the submitted claim.
Corrected claims should only be submitted when payments need adjusting—not for denials.

Support for Optum Maryland ABA Providers

As part of our ongoing commitment, Taylor Prime Solutions supports providers by:

Reviewing and verifying authorization requirements
Submitting claims correctly the first time
Managing backdating exception requests
Monitoring updates from Optum Maryland and COMAR
Assisting with billing for direct services, supervision, caregiver training, and coordination of care

We also help providers navigate Optum’s ABA-specific rules, such as:

97153 and 97155 can be billed concurrently (with the participant present).
Parent training services (97156) must use modifier U2 if the child is present.
Supervision services must equal at least 10% of direct ABA hours.

Why Providers Trust Taylor Prime Solutions for Maryland’s ABA Billing

We’ve helped countless ABA providers succeed through clear guidance, strategic claims submission, and continuous education. Our blog series offers real-world insight into the challenges and solutions for ABA billing in Maryland:

What Taylor Prime Solutions Offers: Full-Service Billing for Behavioral Health Providers
Taylor Prime Solutions and Your Specialty: How We Support ABA, SUD, and Mental Health Billing
The Taylor Prime Solutions Process: From Discovery Call to Billing Success

These resources highlight our experience with Maryland’s ABA billing, from understanding Optum’s authorization rules to preparing compliant session notes and coding treatment plans correctly.

Maryland’s ABA Billing Requirements: Key Points You Should Know

Maryland Medicaid has specific rules for Applied Behavior Analysis (ABA) services. Here’s a brief overview of the critical requirements:

Participant Eligibility for ABA services

Must be under 21, reside in the community, and have a diagnosis of Autism Spectrum Disorder (ASD).
Diagnosis must come from a Qualified Health Care Professional (QHCP) such as a developmental pediatrician or clinical psychologist.
A Comprehensive Diagnostic Evaluation (CDE) and referral for ABA must be dated within the last 6 months.

Pre-Authorization Rules for ABA services

Authorization is always required unless commercial insurance is the primary payer.
If commercial insurance denies ABA coverage, obtain a denial letter and submit for Medicaid authorization.
Services must be authorized before they’re rendered unless exceptions apply.

Billing Guidelines for ABA services

Use the rendering provider’s NPI on claims.
Include accurate Place of Service (POS) codes, such as:
- 03 (School), 11 (Office), 12 (Home/Community)
Use modifiers like GT (Telehealth) and U2 (child present during parent training).
Submit detailed session notes for every billed service.
Use CPT codes appropriately: 97153, 97155, 97156, H2012, and others as defined by COMAR.

For a full breakdown of covered services, supervision ratios, parent training requirements, and session documentation standards, review the Maryland Medicaid ABA Billing FAQs or contact us directly.

We Have A Fully Trained Advantage in Maryland’s ABA Billing

When you partner with Taylor Prime Solutions, you get more than a billing company—you gain a dedicated ABA billing department that works inside the Optum portal and keeps up with all Medicaid updates. We provide:

Claims scrubbing and denial prevention
Appeals and corrected claims support
Backdating exception requests and tracking
Code-specific billing accuracy and unit management
Monthly reporting + performance reviews

We’re proud to say our clients see faster reimbursement, lower denial rates, and more time to focus on patient care—not paperwork.

“We chose Taylor Prime because of their attention to detail and their experience with Maryland’s ABA billing. Our claims are processed faster, and we no longer worry about missed modifiers or rejected sessions.”
— ABA Provider in Clinton, MD

Contact Taylor Prime Solutions Today for Maryland’s ABA Billing Support

Let’s take the stress out of billing. Whether you’re launching ABA services or need help cleaning up aged claims, we are here to help.

Call: 844-TAYLOR-9 (844-829-5679)
Email: info@taylorprimesolutions.com
Website: www.taylorprimesolutions.com
We serve Maryland ABA providers statewide from our office in Baltimore.