Washington Cut ABA Rates 2% in January, and Designed the Cut to Reach MCO Contracts

HCA lowered the Apple Health fee schedule for every core ABA code by 2% on January 1 and the H2020 day-treatment rate on July 1, to deliver a legislated managed care savings target. It chose the fee schedule because many MCO contracts are pegged to it.

Washington's Apple Health fee schedule for ABA dropped 2% on January 1, 2026. The per-diem day treatment code, H2020, followed on July 1. HCA says the cuts “remain in effect on an on-going basis, absent legislative adjustments or further direction.”

The turn: aimed at the fee schedule, felt in the MCO contract

The 2025–27 operating budget told HCA to reduce managed care rates by 1%, about $90 million, in calendar 2026. HCA couldn't reach that by recontracting in time. Its explanation: “changing the FFS fee schedules will result in changes to MCO provider reimbursement levels without requiring recontacting” [sic], because many providers' MCO contracts are structured around the fee schedule.

So a practice that bills almost nothing fee-for-service can still be paid less. Whether it is depends on whether its plan contracts reference the HCA schedule.

HCA's draft list had ABA cuts of 2%–15%. The final was 2% across the board, rolling back “a portion of the CY 2024 15%–20% rate increase.”

The numbers

  • 97153: $12.65 → $12.40
  • 97151: $19.17 → $18.79
  • 97155: $14.38 → $14.09
  • 97156: $18.69 → $18.32
  • 0362T: $60.00 → $58.80
  • 0373T: $24.60 → $24.11
  • 97154 and 97158 for two clients: $12.65 → $12.40 per client; 97157 for two: $10.55 → $10.34
  • H2020 (clinic, per diem): $582.96 → $571.30 on July 1. The outpatient hospital line (revenue code 0509) moved to EAPG payment.

The team conference codes moved the other way on July 1: 99366 rose from $23.36 to $28.78 and 99368 from $20.00 to $20.87.

The limits

HCA's FAQ says all ten codes changed January 1, but its published schedules show H2020's cut dated July 1. How much of the cut reached any given MCO payment depends on that contract, and HCA only says “many” are structured this way. The FAQ also lists “95158,” which is a typo for 97158; the schedules confirm 97158 was cut.

What you must know or do

  • Owners: open each Apple Health MCO contract and find the reimbursement clause. If it pays a percentage of the HCA fee schedule, your rate fell on January 1 without an amendment.
  • Billing: compare one 97153 unit paid in December 2025 with one paid in February 2026 for each plan. A 2% drop confirms the peg. No drop means it doesn't apply to that contract.
  • Day treatment programs: check H2020 remittances after July 1 for $571.30 in clinic settings, and for EAPG pricing on hospital claims.
  • Bill 99366 and 99368 where you deliver team conferences. They're the two ABA-adjacent codes that went up.