Maryland Medicaid ABA telehealth 25 percent in person 2026 comes from PT 60-26, effective April 1, 2026. The one-page transmittal says 97155, 97156 and 97156-U2, and 97157 may no longer be delivered entirely by telehealth: at least 25% must be in person and up to 75% may use telehealth, with GT for qualifying audiovisual delivery. The February manual still contains older language, so later-source review is mandatory.

Apply the later transmittal by code

Lock member, program, authorization, code, modifier, provider, service dates, modality, setting, and policy version. PT 60-26 expressly supersedes PT 11-22 for telehealth guidance. Check the current Maryland ABA program page for later materials. The transmittal does not name 97151, 97152, 97153, 97154, 97158, 0362T, or 0373T. Do not generalize the ratio to unlisted services or interpret silence as telehealth permission.

Define the denominator with Maryland

The phrase at least 25% of the service needs an operational denominator: code, authorization, treatment-plan interval, billing cycle, calendar period, or another state-defined unit. PT 60-26 does not spell that out. Before automation, obtain written MDH or Carelon direction for the measurement period, rounding, partial intervals, new and ending authorizations, missed sessions, provider changes, and exceptions. Preserve the response. The test packet should include one ordinary authorization, one authorization crossing April 1, one short initial period, one early discharge, one missed in-person visit, one corrected claim, and one provider change. For each scenario, show the denominator, qualifying in-person units, qualifying audiovisual units, excluded units, calculated percentage, modifier, edit result, exception route, and reviewer signoff. This makes a configuration decision reproducible without converting an unresolved interpretation into an unstated rule. Retain the approved test evidence with the dated Maryland response and configuration change record.

Resolve the manual conflict visibly

The February 1 ABA manual still says the listed services may be delivered via audiovisual telehealth without the new percentage. Treat PT 60-26 as the later targeted instruction while retaining a mandatory Maryland authority review because the current manual has not been fully reconciled. The article must remain noindex until MDH confirms the source order, denominator, and any updated manual.

Keep clinical appropriateness and billing separate

A 75% maximum is not a clinical recommendation to use telehealth, and a 25% minimum does not make an in-person session medically necessary by itself. Qualified clinicians should assess member needs, safety, caregiver access, technology, privacy, treatment goals, setting, and effectiveness using current Maryland telehealth resources. Operations should record actual modality and use GT only for qualifying two-way HIPAA-compliant audiovisual delivery. Never relabel a telephone or in-person service.

A fictional Maryland modality audit

Jules locks 34 active authorizations for the named codes. Twenty-six have a verified source order, written denominator, actual modality, in-person percentage, GT logic, clinical appropriateness record, and exception owner. Completeness is 26 of 34, or 76.5%. Three use the old manual alone, two lack a denominator, one counts canceled visits, one applies GT to audio-only, and one treats 75% as the treatment target.

Handle shortfalls without falsifying care

If the measured period approaches a shortfall, confirm the denominator, authorization, member availability, clinical plan, access barriers, and any state exception. Communicate early with the family and payer using accessible language, but do not schedule clinically unnecessary contact or alter modality records solely to satisfy billing. Preserve continuity planning and the payer's written determination for services already delivered.

Maryland telehealth checklist

For Maryland Medicaid ABA telehealth 25 percent in person 2026, verify PT 60-26, April 1 effective date, superseded PT 11-22, current ABA manual and conflict, MDH source-order confirmation, member and eligibility, authorization, code 97155, 97156 or U2, or 97157, denominator and rounding, actual in-person and telehealth units, audiovisual technology and privacy, GT modifier, clinical appropriateness, provider and setting, treatment plan, claim and denial, exception, continuity action, staff training, tested edit, and source recheck.

Related resources

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