Arizona Stops Paying 58.66% of Whatever You Bill for Caregiver Training on Thursday

Arizona's final FFY27 ABA fee schedule takes effect October 1, 2026. Two codes that have never had a rate now have one.

CPT 97156 (family adaptive behavior treatment guidance) and 97157 (multiple-family group guidance) have carried “BR” — By Report — on the AHCCCS schedule with an effective date of January 1, 2019. In practice that meant, in the agency's own words: “providers submit a FFS claim and are paid 58.66% of the billed rate they submit.”

AHCCCS is blunt about why it is stopping: “This methodology, while a longstanding practice, leaves the Arizona Medicaid program exposed to potential fraudulent billing and criminal activity.”

The turn: this is a much smaller rule than it sounds

It does not touch most Arizona ABA. The agency's FAQ draws the line itself: “The new proposed rate is only applicable to Fee-For-Service providers who serve members in the American Indian Health Program (AIHP), Tribal ALTCS program, and DDD Tribal Health Program. It has no impact on the contracts that AHCCCS health plans negotiate with their providers.”

Three programs. If you bill Mercy Care, Banner–University Family Care, Care1st, UnitedHealthcare Community Plan, Molina Complete Care or Arizona Complete Health, nothing here changes your rate.

The numbers, per 15 minutes

• 97156: no modifier and HN $23.97 · HO $28.53 · HP $35.67. In the home (place of service 12): $26.53 · $31.58 · $39.47.
• 97157: no modifier and HN $7.99 · HO $9.51 · HP $11.89. Place of service 12: $8.84 · $10.53 · $13.16.
• 97154 with the TJ modifier: $14.93 → $16.95. Plain 97154 stays at $4.48.
• Unchanged for FFY27: 97151 $30.06, 97153 $17.91, 97155 $25.05, 97158 $6.26, all at the base modifier.

On TJ, AHCCCS is specific about who may use it: “this code can only be used by a highly specific group of providers that provide the ABA model delivered in a community school setting as follows: ratio of ABA techs to patients in a community school setting must have multiple providers working with multiple patients i.e. 2 providers with 3 children.”

The limits

Comments closed August 24. The $6,337,038 the notice estimates is the increase across every AHCCCS fee schedule, not ABA alone — do not read it as an ABA number. And 0362T and 0373T do not appear on the Arizona ABA schedule at all, so the January 1 Category III deletions change nothing here.

What you must know or do

• If you bill AHCCCS fee-for-service, reprice 97156 and 97157 for dates of service from Thursday. Whatever margin the percent-of-charges method gave you is gone, and the new number is a cap.
• Check your modifier hygiene before Thursday, because the spread is now all modifier. HP pays roughly 49% more than HN on 97156. A doctoral-level session billed without HP leaves $11.70 an hour on the table.
• Use place of service 12 where the training happened at home. Every tier pays about 10.7% more; coding a home session as office costs $2.56 to $3.80 a unit.
• Before you append TJ, confirm you meet the ratio definition. $16.95 against $4.48 is a 3.8-times difference on the same code, which makes it an obvious place for AHCCCS to look.