CMS pushes tighter prior auth for Medicaid ABA therapy

Medicaid spending on ABA hit about $10 billion in 2025, up from $2 billion in 2021, which is why CMS is tightening oversight. Its toolkit (https://www.crowell.com/en/insights/client-alerts/cms-offers-guidance-as-scrutiny-rises-over-aba-therapy-in-medicaid) steers plans toward prior authorization, concurrent review and reauthorization tied to codes 97151 through 97158, with independent ASD diagnosis and closer review of high-intensity requests.