Maryland ABA Therapy 2026: What Families Need to Know About the Carelon Transition and July Billing Changes

Published August 14, 2026 • 6 min read
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Maryland families relying on Medicaid to cover Applied Behavior Analysis (ABA) therapy have navigated a series of program changes in 2026: a new administrative services organization managing authorizations, a rewritten provider manual effective February 1, 2026, and a claims requirement that took effect July 1, 2026. Here is what you need to know.

What Changed: Carelon Replaced Optum as Maryland's ABA Gatekeeper

Carelon Behavioral Health now serves as Maryland's Behavioral Health Administrative Services Organization (BHASO), taking over from Optum. The Maryland Medical Assistance Program ABA Provider Manual, effective February 1, 2026, names Carelon as the BHASO and states that "all ABA services require prior authorization from the BHASO."

For families, this means a new point of contact for:

  • Prior authorization requests before ABA therapy begins
  • Treatment plan reviews and authorizations for continued services
  • Claims disputes and coverage questions

If your provider previously worked through Optum, they have already transitioned to Carelon. The provider portal for ABA communications is available at maryland.carelonbh.com, and your ABA provider can contact Carelon directly with authorization and billing questions.

July 1, 2026: New NPI Requirement on All ABA Claims

A Carelon provider alert dated April 30, 2026 relayed a Maryland Department of Health transmittal: "Effective July 1, 2026, ABA providers must include the National Provider Identifier (NPI) of the referring practitioner on claims and must verify the referring practitioner's active enrollment with Maryland Medicaid on all monthly claim submissions." Note the second half of that sentence, which is easy to miss: it is not only the NPI, it is confirming that the referring practitioner is still actively enrolled, every month.

This means your child's ABA provider needs the NPI of whoever referred your child to ABA therapy, typically your pediatrician, developmental pediatrician, or the physician who provided the autism diagnosis. If your provider does not have this information on file, claim denials will follow.

What families should do now:

  • Confirm your ABA provider has your referring physician's NPI on file, and that the referring practitioner is actively enrolled with Maryland Medicaid
  • Contact your pediatrician's office if you are unsure who the referring provider of record is
  • Ask your ABA provider whether they have updated their billing systems for this requirement

This change does not affect your child's coverage eligibility. It is a billing documentation requirement. However, if your provider misses it, you could experience service disruptions while the billing issue is resolved.

Maryland ABA Medicaid Reimbursement Rates in 2026

The rates are published in the state's own ABA Provider Manual, which is useful if you want to understand how your child's sessions are billed. Per the February 1, 2026 manual, all in 15-minute units:

  • CPT 97151 (behavior identification assessment, psychologist/BCBA-D/BCBA): $38.34, up to 32 units
  • CPT 97152 (supporting assessment, BCaBA/RBT/BT): $19.17, up to 32 units
  • CPT 97153 (adaptive behavior treatment by protocol): $24.41 when delivered by a psychologist, BCBA-D or BCBA, $19.17 when delivered by an RBT or BT, up to 32 units
  • CPT 97155 (adaptive behavior treatment with protocol modification, psychologist/BCBA-D/BCBA): $38.34, up to 24 units, with the GT modifier signifying remote direction of a technician
  • CPT 97156 (family adaptive behavior treatment guidance): $20.91 or $38.34 depending on the delivering practitioner, up to 16 units

Your Core Coverage Rights Have Not Changed

Despite these administrative and billing changes, the fundamental legal protections for ABA therapy coverage in Maryland remain firmly in place.

EPSDT federal protection: Under the federal Early and Periodic Screening, Diagnostic and Treatment benefit, Maryland Medicaid must cover medically necessary services for children and youth under age 21, including ABA therapy. CMS's 2026 EPSDT guide for states says flat or arbitrary limits, including rigid visit or hour caps and fixed cutoffs, cannot substitute for an individualized medical necessity determination.

Prior authorization: The manual is specific here. "Preauthorization for services from the BHASO are valid for a maximum of 180 days," and before the end of that period a psychologist, BCBA-D or BCBA must complete a reassessment to determine whether services remain medically necessary. That reassessment and reauthorization cycle repeats every 180 days for the duration of treatment. Your ABA provider handles this process on your behalf.

Mental health parity: The federal Mental Health Parity and Addiction Equity Act prevents the plans it applies to from imposing stricter treatment limitations on mental health and substance use benefits than on comparable medical or surgical benefits.

Fair hearing rights: If a service is reduced or denied, you have appeal rights. Under 42 CFR 431.211 the agency must send notice at least 10 days before the date of action, and under 42 CFR 431.230 services generally continue if you request a hearing before that date. For managed care, the parallel rule is 42 CFR 438.420. Contact your county Department of Social Services or Maryland Legal Aid for help with appeals.

Private Insurance ABA Coverage in Maryland

Families with commercial insurance rather than Medicaid are covered under state insurance law rather than this manual. The NCSL summary of state autism insurance laws is the place to check what your state mandate requires and what limits it permits. Self-funded employer plans are generally exempt from state mandates under the federal Employee Retirement Income Security Act and may have different coverage rules, so ask your HR or benefits department whether your plan is fully insured or self-funded.

Finding ABA Providers in Maryland

With the transition from Optum to Carelon and new billing requirements taking effect, some providers may adjust their Medicaid acceptance status. When searching for ABA therapy in Maryland, ask each provider:

  • Are you credentialed with Carelon Behavioral Health of Maryland?
  • Do you accept HealthChoice managed care or fee-for-service Medicaid?
  • Are you currently accepting new Medicaid patients?
  • What is your current waitlist timeline for new clients?

Use the ABA Navigator directory to find ABA therapy providers in Maryland who are accepting new patients. Our directory lists providers by city and county, with information on insurance accepted, so you can search for providers who take Maryland Medicaid. Our complete Maryland ABA therapy guide covers eligibility and getting started, and our step-by-step guide to getting ABA therapy puts diagnosis, referral and authorization in order.

Important Note

This article is for informational purposes only and is not legal, medical or insurance advice. Maryland Medicaid manuals, fee schedules and billing requirements change. Confirm the current rules with the Maryland Department of Health, Carelon, or your ABA provider before acting on anything here.

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