How Much Does ABA Therapy Cost?
What ABA therapy costs, what your plan can and cannot cap, and the published Medicaid rates. Put in your own quote and see the real number, sourced.
Most pages answer this with a national average. We are not going to, because the average is not your number and quoting one would be the least useful thing we could do.
Here is the honest version. ABA is billed in 15 minute units, so four units make an hour. What one unit is worth depends on who is paying, and the gap between payers is wide enough that a single figure is meaningless. What we can do is show you the published rates where a state publishes them, and then apply the actual coverage rules to whatever rate you have been quoted.
Checked 13 August 2026.
Calculator loading. If it does not appear, the short version is this: ask your provider for their rate for code 97153, multiply it by your weekly hours and by 52, then read the cap section below to see what your plan can do with that figure.
Why we ask you for the rate instead of telling you
Commercial insurers negotiate rates with each provider individually and do not publish them. There is no primary source for what a private plan pays in New Jersey, Georgia or North Carolina, which is why every page quoting you a confident hourly figure is quoting somebody's estimate.
So the calculator asks for your number. Get it from a provider's written quote, or from an explanation of benefits if treatment has already started. That is a real figure for your family rather than a national one for nobody.
What we bring is the other half: the rules that decide what your plan can do with that number once it has it.
What Medicaid actually pays, where it is published
Two of the three states we serve publish their Medicaid rates, and those figures are worth knowing even if your child is on a commercial plan, because they are the only public benchmark that exists.
Georgia publishes a full Autism Spectrum Disorder fee schedule. The rate depends on the practitioner level and where the service happens: "Code 97153, adaptive behavior treatment by protocol, delivered by a U5 practitioner in the home, pays $18.69 per 15 minute unit." That is $74.76 an hour. The same code outside the home pays less, and supervision by the analyst pays considerably more.
North Carolina lists "Code 97153, adaptive behavior treatment by protocol, is listed at $18.09 per 15 minute unit on the archived sheet, which is a non facility fee." Read that carefully, because there is a catch: NC Medicaid moved its behavioral health fee schedules to a separate portal in November 2022, so the sheet we can cite is a base rather than the live rate.
New Jersey we could not source at all. The Division of Medical Assistance and Health Services publishes provider resources and service manuals, but no adaptive behavior fee schedule we could reach. Rather than estimate, we say so. Ask your managed care plan for the fee schedule in writing.
The number to ask about in all three states is code 97153. That is the code for direct treatment, and it is where most of the hours sit.
The cap is not the number you think it is
Every state we serve has an annual dollar cap in its autism mandate, and in all three the headline figure misleads.
New Jersey, $36,000. On the books, but frequently unenforceable. The Department of Banking and Insurance says carriers "may not be able to limit the benefit as described," because federal parity rules collide with the cap. We walk through why on the New Jersey funding guide.
North Carolina, $40,000. A 2015 base, not the live ceiling. The statute indexes it: "beginning in 2017 and for subsequent years, the amount shall be indexed using the Consumer Price Index for All Urban Consumers for the South Region." Ten years of indexing means the real figure is higher, and we could not find it published anywhere citable. The North Carolina guide has the full text and the sentence to send your insurer.
Georgia, $35,000. Live, but narrower than it looks. The statute says "The policy or contract may limit coverage for applied behavior analysis to $35,000.00 per year." It is a ceiling a plan may apply, not a budget you are given, and it attaches to ABA specifically. The Georgia guide covers what else changed in 2019.
There is one piece of good news that applies across the board. Georgia's statute states plainly that "The policy or contract shall not include any limits on the number of visits." Where a plan tells you it will authorize a fixed number of sessions, that is worth challenging.
The question that decides everything: is your plan self-funded?
If you read nothing else here, read this.
State mandates bind insurance. Many employers, particularly larger ones, do not buy insurance: they pay claims from their own money and hire an insurance company only to administer the plan. That is a self-funded plan, and no state mandate reaches it. Neither does the state appeal process.
The reason is federal. ERISA preserves state insurance regulation and then removes self-funded plans from its reach, so a plan is not to "be deemed to be an insurance company or other insurer ... or to be engaged in the business of insurance ... for purposes of any law of a State purporting to regulate insurance companies, insurance contracts, banks, trust companies, or investment companies."
How to check in two minutes. Ask your plan administrator directly. Read the Summary Plan Description, which must be given to you free and which sets out "how it works, what benefits it provides, how to file a claim for benefits, and any limitations that may apply." Or look at a denial letter: the US Department of Labor notes that "the external review process used by the plan depends on whether the plan is self-funded or provides benefits through an insurance company. The claim denial notice from your plan will describe the external process and your rights."
Being self-funded is not bad news by itself. Those plans have federal appeal rights and many cover ABA generously. It only means the state cap and the state appeal route are not levers you hold. If the vocabulary in your plan documents is the obstacle, our plain English guide to insurance terms works through it.
What drives your number up or down
Hours. The single biggest factor. Recommendations commonly run 15 to 25 hours a week, and Georgia Medicaid notes that "therapy can range from 10-30 hours per week, or more if medically necessary, and requires active parent/caregiver participation and involvement."
Who delivers each hour. Direct treatment and analyst supervision are different codes at different rates. In Georgia the top practitioner level in the home reaches "Code 97155, treatment with protocol modification by the supervising analyst, pays $76.31 per 15 minute unit at the U1 practitioner level in the home", against $18.69 for direct treatment. A programme is a mix of both, so the blended cost sits between them.
Where it happens. Georgia pays more for services in the home than in an office, which is unusual and worth knowing if you are weighing settings.
Parent training. Often overlooked in cost planning and separately billable. Georgia lists "Code 97156, parent training with or without the child, pays $27.52 per 15 minute unit at the U1 level in the home."
Your copay and coinsurance. The part families most often forget. A plan can cover ABA fully and still leave a meaningful monthly bill through cost sharing.
Where the number stops being knowable
We would rather show you the edge of what we know than paper over it.
We cannot tell you what a commercial plan pays, because nobody publishes it. We cannot tell you North Carolina's current indexed cap, or its current Medicaid rate, because the citable sheet is a base and the live figure sits in a portal. We cannot tell you New Jersey's Medicaid rate at all.
In each case the calculator says so instead of filling the gap with something plausible. A confident wrong number costs a family more than an honest gap, because they plan around it.
If the obstacle turns out to be affordability rather than coverage, our round-up of financial aid programs covers grants, waivers and the routes that exist outside insurance. If it is the diagnosis you are costing out rather than the therapy, that is a different question with different numbers.
Why Mastermind Behavior
Every figure on this page came out of a state fee schedule, a session law or a federal statute, read directly and dated so you can see how current it is. Where the source did not answer, we left the gap visible rather than filling it, because that is the difference between a page you can act on and a page that reads well.
That is the same conversation we have with families every week. It is usually the first one, not an afterthought. Mastermind Behavior is a BCBA-owned provider delivering in-home ABA therapy across New Jersey, Georgia and North Carolina, and we will help you work out what your plan owes before you commit to anything. If we are not the right fit, we will tell you that too. You can talk it through with us.
Sources
Every figure on this page was checked against these documents on 13 August 2026.
- Georgia Medicaid ASD Fee Schedule, published through the GAMMIS provider portal.
- NC Medicaid, Other Behavioral Health Services Fee Schedules Archive, and the Research Based Intensive Behavioral Health Treatment fee schedule.
- NJ Department of Human Services, Division of Medical Assistance and Health Services, checked for a published ABA fee schedule.
- Georgia SB 118, 2017-2018 session, amending O.C.G.A. 33-24-59.10.
- N.C.G.S. 58-3-192, coverage for autism spectrum disorder.
- New Jersey Department of Banking and Insurance guidance on the autism mandate and federal parity.
- 29 U.S.C. 1144(b)(2), ERISA saving clause and deemer clause.
- US Department of Labor, Employee Benefits Security Administration, Filing a Claim for Your Health Benefits.
