How to Start an ABA Therapy Business in 2026 (12-Step Guide)

Starting an Applied Behavior Analysis (ABA) therapy business can feel overwhelming because you’re essentially building a healthcare practice, a regulated service, and a business all at the same time. 

This guide breaks down how to start an ABA therapy business step by step, so you can avoid the mistakes that slow down most new clinics.

Step 1: Decide what kind of ABA business you’re building

Before you get to the paperwork, software, and logos, you’ll need to decide what problem your clinic will solve.

Ask yourself:

• Who will you work with? Toddlers, school-age kids, or adults?
• Where will you provide therapy? In homes, at a clinic, or both?
• How will families pay? Insurance, Medicaid, or out-of-pocket?

Your answers will affect everything that follows, all the way from staffing to billing.

There’s a big temptation for first-time owners to skip this step and copy nearby clinics. But copying others means you end up fighting for the same clients without standing out. And that’s just a recipe for tight budgets and exhaustion.

It’s much better to know what you want and do your own thing from the very start.

Step 2: Choose your business structure and register your company

Before you do anything else, you'll need to decide how your business is legally structured. This affects your taxes, your personal liability, and your ability to get funding.

The most common options are sole proprietorship, partnership, and limited liability company (LLC).

A sole proprietorship is the simplest to set up, but it offers no protection if something goes wrong, so your personal assets will be on the line.

A partnership works if you're starting with a co-owner, but it comes with similar liability concerns.

An LLC requires more paperwork, but it protects you personally from business losses and lawsuits.

For most ABA clinics, an LLC is the safer choice. However, because every situation is different, it's worth consulting an accountant or attorney before making a decision.

Once you've chosen your structure, you'll need to register your business with your state and get an Employer Identification Number (EIN) from the IRS.

You'll also want to choose a name that's easy to remember, check that it's available in your state's business registry, and secure a matching domain for your website.

Step 3: Find the right location

Your service model will determine whether you need a physical clinic or whether you can start with in-home services only.

In-home ABA therapy keeps overheads low since you're not paying rent on a commercial space.

If you want to offer clinic-based services, you'll need to factor in lease costs, build-out expenses, and accessibility requirements.

Some clinics start with a hybrid model, offering in-home services to begin with, then adding a physical location once revenue is more consistent.

If you're renting space, the costs vary significantly by city and size. Larger cities tend to have higher rents, while rural areas are more affordable. Some providers also rent office space by the hour to keep costs flexible in the early months.

Step 4: Confirm your clinical leadership requirements

Most ABA therapy businesses require a Board Certified Behavior Analyst (BCBA) to oversee their services.

In most states, a BCBA must supervise treatment. The BCBA may need to be an owner, employee, or contracted clinical director.

You should review the current BACB supervision and ethical requirements before structuring and setting your clinic’s leadership roles in stone.

Step 5: Research state licensing and insurance credentialing

ABA clinics are regulated at the state level, so requirements can vary widely.

Common requirements will typically include healthcare facility licensing, Medicaid enrollment, background checks for staff, and clinical policy documentation.

Licensing delays are one of the biggest launch blockers, so check your state’s health department and Medicaid agency early on in the process.

You'll also need to get credentialed with insurance providers if you plan to accept insurance as payment. Credentialing is the process of becoming an approved provider on an insurer's panel, and it can take anywhere from a few months to over a year.

Each insurance provider has different requirements, payout timings, and reimbursement rates, so start the credentialing process as early as possible. Delays here directly affect when you can start generating revenue.

Step 6: Write a lean ABA business plan (not a 40-page novel)

You don’t need a fancy pitch deck or pages and pages of technical detail. You just need a clear plan.

Your plan should answer key questions, like:

• Who do we serve?
• How do we get paid?
• What does it cost to deliver care?

You should also include expected authorization units, billing timelines, and a staffing model, such as BCBA to Registered Behavior Technician (RBT) ratios.

The real test isn't how fast you can grow in the first year, it's whether you can cover payroll while waiting on reimbursements. Focus on sustainability first and growth second.

Step 7: Secure startup funding (more than you think you need)

ABA businesses can eat through cash in the early months, so you'll probably need a larger budget than you first think.

It’s a good idea to secure funding that covers at least 6–9 months of operations before consistent revenue kicks in.

Costs often include credentialing delays (which can take months), payroll before reimbursements, and software and compliance tools.

And research shows that reimbursement delays are common in early-stage practices, so try to budget for 3–6 months of payroll before cash starts flowing consistently.

Step 8: Hire clinical staff strategically (not all at once)

Don’t get in over your head by hiring a full team on day one. Over-hiring early can put strain on ABA clinics as much as lack of demand.

Start out small with one BCBA, a small group of RBTs, and a part-time admin or billing support.

You can then ramp up your hiring as authorizations are approved and your caseload grows.

As you grow, set clear limits for how many clients each BCBA can supervise and the maximum caseloads per clinician.

The clinics that last are the ones that grow strategically, not frantically.

Sustainable growth protects your team, your clients, and your business. You don’t want anyone to burn out or become overwhelmed.

Step 9: Build a compliance-first clinical model

ABA clinics have to follow thorough compliance rules. Mistakes in documentation or billing can lead to audits, denials, and payment clawbacks.

You’ll need systems for documenting sessions, tracking supervision, updating treatment plans, and limiting authorizations.

Sloppy documentation invites payor audits and could mean having to return payments. So you’ll want to build accuracy into your process from day one.

Beyond clinical documentation, you'll also need policies that govern your business relationships with clients. These include billing and fee structures, cancellation policies, confidentiality and privacy agreements, and liability releases.

Work with an attorney to draft contracts that protect both your clients and your practice.

Step 10: Understand ABA billing before you submit your first claim

There are multiple moving parts to ABA billing, and they all have to match perfectly.

You’ll need to align CPT codes, staff credentials, authorization units, and session duration.

If billing feels confusing at first, that’s completely normal. But you’ll want to get a solid system in place and make sure your team understands exactly how ABA billing works before you submit your first claim.

Once you're submitting claims, don't chase vanity metrics like total sessions delivered. Focus on tracking what affects cash flow, like authorization usage, denial rates, payment timelines, and staff turnover.

These are the numbers that’ll tell you if your ABA business is healthy. Track them weekly, not quarterly, so you can course-correct quickly.

Step 11: Choose systems that match ABA workflows

Before you get into ABA-specific software, make sure you have the basics covered.

Set up a professional business email through Google Workspace or Microsoft 365, but avoid using a personal email address for client communication.

You'll also want a dedicated business phone line, which can be as simple as a Voice over Internet Protocol (VoIP) system like Google Voice.

Your software should reflect how ABA care actually works. The wrong system can create manual workarounds that waste time and lead to errors.

Look for systems where you can track authorizations while you schedule, bill correctly based on staff roles, and connect clinical and administrative workflows.

Generic therapy software tends to fall apart pretty quickly under ABA complexity. It might work at first, but you’re better off with a platform that allows you to scale as you grow.

Step 12: Build your referral network and marketing foundation

Don’t wait until you open your doors to start building referral relationships. They can take time to develop, and you'll want clients ready for when you're set to launch.

Try to build connections early with pediatricians, school districts, Speech and Occupational Therapy (OT) clinics, and parent advocacy groups.

Word-of-mouth from trusted professionals often matters more than marketing spend here. Families tend to listen to their doctors and therapists rather than ads.

Referrals alone won't sustain long-term growth, though. You'll also want to get some basic marketing in place, like registering for a Google Business Profile so families can find your contact details, hours, and location.

Building a simple website that explains your services will also help you show up when parents search for ABA therapy in your area.

And as you start working with clients, you can ask satisfied families for reviews to build trust and help your visibility.

You don't need a big marketing budget to get started. But having these pieces in place early means you're not scrambling to attract clients once you're ready to scale.

Get your ABA business running smoothly from the start with Passage Health

Starting an ABA therapy business means juggling credentialing, authorizations, schedules, billing codes, and client care all at once.

RBTs are delivering sessions, BCBAs are supervising treatment plans, and admin staff are trying to figure out why claims keep getting denied. It can be a lot to keep track of.

But Passage Health connects those clinical and admin sides of your ABA practice so nothing slips through the cracks.

With ​​Passage Health, you get:

• Scheduling that tracks authorizations: See exactly how many units each client has left before booking sessions. No accidental overages or surprise denials.
• Billing with built-in safeguards: Automated billing rules help ensure credentials and CPT codes stay aligned, so you're not manually checking every claim.
• Supervision tracking built in: Know which RBTs need oversight and how many supervision hours each BCBA has available. No spreadsheets required.
• Everything in one place: Session notes, treatment plans, and billing data live in one place, so claims and audits won't turn into scavenger hunts.

Passage Health connects your clinical and billing systems so everything stays in sync. Your team avoids the billing chaos that eats up hours each week, and can focus on what matters: clinical quality and referral relationships that grow your practice.

Book a demo to see how Passage Health can support your ABA practice from day one and help you maintain control as you grow.

Frequently asked questions

How long does it take to start an ABA therapy business?

Starting an ABA therapy business typically takes 6–12 months from planning to launch. This timeline includes things like state licensing, insurance credentialing, and payor enrollment processes.

Do you need to be a BCBA to start an ABA therapy business?

You don't always need to be a BCBA to start an ABA therapy business, but a BCBA must oversee all clinical services. Many states also require the BCBA to be an owner, employee, or contracted clinical director.

How much does it cost to start an ABA therapy business?

Costs for starting an ABA therapy business vary significantly depending on your staffing model, credentialing delays, and whether you're home-based or operating from a commercial space. Major expenses include licensing, insurance, software, initial payroll, and waiting for insurance reimbursements.

Is ABA therapy profitable?

ABA therapy can be profitable if you manage authorizations carefully, maintain healthy staffing ratios, and get billing right. Many clinics struggle with profitability due to reimbursement delays and billing errors.

References

ABA Coding Coalition. (n.d.). ABA CPT codes. Retrieved from https://abacodes.org/codes/

BACB. (2024). Ethics code for behavior analysts. Behavior Analyst Certification Board. Retrieved from https://www.bacb.com/wp-content/uploads/2022/01/Ethics-Code-for-Behavior-Analysts-240830-a.pdf 

Centers for Medicare & Medicaid Services. (n.d.). Healthcare Common Procedure Coding System (HCPCS). U.S. Department of Health and Human Services. Retrieved from https://www.cms.gov/medicare/coding-billing/healthcare-common-procedure-system

Huber, B., Belenky, N., Watson, C., et al. (2023, October 17). Reimbursement mechanisms and challenges in team-based behavioral health care (Issue Brief). Office of the Assistant Secretary for Planning and Evaluation (ASPE). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK606628/ 

Rousseau, M., Batts, K. R., Saavedra, L., et al. (2024, August 1). Barriers and opportunities for improving interstate licensure reciprocity and portability for behavioral health practitioners: Technical expert panel findings (Issue Brief). Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services. Retrieved from https://aspe.hhs.gov/sites/default/files/documents/405ad876b1de337a81b4db0257666586/barriers-opportunities-improving-interstate-licensure.pdf 

Scott, J. A., & Camden, M. (2011). Recovery audit contractor medical necessity readiness: One health system's journey. Professional Case Management, 16(5), 232-237. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21849871/