Medicaid advises states to limit autism therapy billing

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The federal Medicaid office will publish a 173-page set of best practices urging states to restrict how autism therapy providers bill Medicaid after spending jumped from about $2 billion in 2021 to $10 billion in 2025. Officials cited faster cost growth than the 67 percent rise in diagnoses, audits showing billing for nontherapeutic activities, and clinics prescribing very long weeks of care, sometimes 40 hours. The guidance recommends prior authorization for high hours, limits on stacked 15-minute billing units, outcome tracking, and scrutiny for clinics that bill maximum hours for most patients, prompting likely state policy changes and legislative action.

Medicaid autism therapy spending rose to $10 billion in 2025.