The Question · ABA · RBT pay and reimbursement
A guaranteed RBT hour is paid whether or not a unit is billed.
Clinics want to pay RBTs through cancellations to keep them. A cancelled session bills nothing, and 97153 rates fell in several states. Here is the math, the supervision rules that sit on top, and the billing data that tells you what you can afford.
By ASP-RCM Editorial, Healthcare RCM Practice · Updated
The question we asked on LinkedIn
Guaranteed hours for RBTs through cancellations: can an ABA clinic afford it when payers cut rates?
Nebraska RBT rate per 15 min
Down from $36.11 on August 1, 2025, a 48% cut, per Nebraska Public Media
New York 97153 technician unit
NYS Medicaid fee-for-service, dates of service from October 1, 2026
Indiana 97153 U1 from April 2027
Was $17.06, then $16.04 from April 1, 2026, per IHCP bulletin BT202627
BACB minimum RBT supervision
Of the hours the RBT provides services each calendar month, RBT Handbook, October 2026
What one RBT hour of 97153 pays, by fee schedule
Four 15-minute units per delivered hour. A cancelled hour pays none of these.
Arithmetic on published per-unit Medicaid fee-for-service rates (Nebraska Public Media table of DHHS rates, IHCP BT202627, NYS Medicaid Update August 2026). Managed care contracts can pay differently; check yours in the ABA payer matrix.
How a guaranteed hour turns into cost
The promise is made to the RBT. The payer only pays for time spent with the client.
Hour scheduled
The RBT is booked against an authorization for 97153 units.
Family cancels
Illness, school events, transport. The session does not happen.
RBT is still paid
Under a guarantee, payroll runs as if the hour was delivered.
No unit is billed
97153 is billed for time with the client. A missed session is not a claim.
Delivered hours carry it
Every billed hour now funds its own wage plus a share of the unbilled ones.
Supervision rules that sit on top of RBT time
Supervision is staff time too. Some states now set a higher floor than the BACB.
| Rule | Requirement | Effective |
|---|---|---|
| BACB, all RBTs | At least 5% of service hours each calendar month, two real-time contacts, one with the RBT observed with a client | Current, RBT Handbook October 2026 |
| Indiana Medicaid | One hour of BCBA or approved supervisor time for every eight hours of technician-delivered ABA | April 1, 2026, BT202627 |
| North Carolina Medicaid | At least 10% of paraprofessional services with LQASP observation and direction; RBT or ABAT certification after a 120-day grace | August 1, 2026, Clinical Coverage Policy 8F |
| New York Medicaid | 97153 by unlicensed individuals or technicians paid at $9.63 per unit | October 1, 2026 |
BACB supervision is counted on hours the RBT provides services. Paid but cancelled hours do not add service hours, but they do not reduce the supervision you owe either.
Rate actions that hit RBT-delivered units
Medicaid agencies and Medicaid plans, in date order.
- Aug 1, 2025
Nebraska RBT rate to $18.70 per 15 minutes, from $36.11.
- Apr 1, 2026
Indiana cuts nongroup ABA rates 6%, adds a 1 to 8 supervision rule.
- Apr 8, 2026
CareSource Georgia tells providers it will pay 80% of the state fee schedule from early May (Behavioral Health Business). Lawmakers later said it pulled back.
- Aug 1, 2026
North Carolina requires RBT or ABAT certification for paraprofessionals, with a 120-day grace.
- Sep 1, 2026
Amerigroup Georgia, the plan for children in foster care, cuts ABA payments 30%.
- Oct 1, 2026
New York pays technician 97153 at $9.63 per unit.
- Apr 1, 2027
Indiana takes 4% more off all ABA codes. 97153 U1 goes to $15.39.
Two ways to offer a guarantee
Retention matters. The question is whether the promise is priced from your own billing data.
Funded blind
- Guarantee set at full authorized hours for every RBT
- No view of cancellation rate by client, payer or time slot
- Rate cuts absorbed with no change to the guarantee
- Supervision hours not counted in the cost of an RBT hour
Funded from billing data
- Guarantee sized to the delivered share of authorized hours
- Cancellation rate tracked by cause, client and payer
- Paid rate per 97153 unit checked on every remit
- Supervision time per RBT hour included in the cost
Three numbers to pull before you promise hours
Delivered vs authorized
Billed 97153 units divided by authorized units, per client and per month. This is the real ceiling on revenue.
Cancellation rate by cause
Cancelled sessions over scheduled sessions, split by family, staff and payer reasons. Only some of it is fixable.
Paid rate per delivered hour
What the 835 actually paid for four units of 97153, by payer, after every 2026 rate change.
Can your clinic fund a guarantee?
Tick what you can answer from your own data today.
A guarantee is paid on scheduled hours. Revenue comes from delivered units at today's rate. Size the promise to your delivered share, your cancellation rate by cause and the rate your remits actually show.
Questions operators ask next
Can an ABA provider bill Medicaid for a cancelled RBT session?
No. CPT 97153 describes adaptive behavior treatment delivered by a technician with the client, billed in 15-minute units. If the session does not happen, there is no service to bill. Any pay the RBT receives for that hour comes out of the margin on hours that were delivered.
How much supervision does an RBT need?
The BACB RBT Handbook requires ongoing supervision for at least 5% of the hours the RBT provides behavior-analytic services each calendar month, with two real-time contacts and at least one observation with a client. Some Medicaid programs set more: Indiana requires one supervisor hour per eight technician hours from April 1, 2026.
Which states cut Medicaid rates for RBT-delivered ABA?
Nebraska cut its RBT rate to $18.70 per 15 minutes from August 1, 2025. Indiana cut nongroup ABA rates 6% from April 1, 2026, with 4% more on April 1, 2027. New York pays technician 97153 at $9.63 per unit from October 1, 2026. In Georgia, Amerigroup cut ABA payments 30% from September 1, 2026.
What billing data should a clinic review before guaranteeing RBT hours?
Start with three numbers: delivered 97153 units as a share of authorized units, the cancellation rate split by cause, and the rate actually paid per unit on remits from each payer. Add supervision time per RBT hour. Together they show what one delivered hour has to cover.
Know what a delivered RBT hour really pays you
Send us 90 days of ABA claims, remits and authorizations. A senior ABA billing partner shows you delivered versus authorized hours, cancellation patterns and paid rate per 97153 unit, in a free 30-minute call with a written gap report after.
Keep reading
Sources
- Indiana FSSA, IHCP bulletin BT202627, ABA therapy changes, February 26, 2026
- NYS Medicaid Update, August 2026, 97153 reimbursement change
- Nebraska Public Media, Medicaid ABA rate cuts, July 18, 2025
- BACB, Registered Behavior Technician Handbook, October 2026
- NC Medicaid, RB-BHT service delivery requirements, August 31, 2026
- WABE, Georgia cuts payments 30% for foster children's autism therapy, October 5, 2026
Checked November 4, 2026. Rates are published Medicaid fee-for-service amounts or reported plan actions; managed care contracts vary. Confirm current rates with your state and plans. General information, not legal or employment advice.