Navigating the complex world of ABA therapy can be challenging, especially when it comes to accurately documenting and billing for services. A key component of successful billing and reimbursement in ABA is the utilization of Current Procedural Terminology (CPT) codes. In this article, we will explore the importance of ABA Therapy CPT codes and highlight several helpful codes that play a significant role in the billing process.
What are ABA Therapy CPT Codes?
CPT codes, established by the American Medical Association (AMA), serve as a standardized system to identify and bill for medical procedures and services. ABA CPT codes provide a common language that enables providers and insurers to accurately document and communicate the interventions delivered. These codes are updated annually by the AMA, so it’s important to stay up-to-date to ensure reimbursement for services.
Key 2023 ABA CPT Codes
Evaluation and Assessment
- 97151: Comprehensive adaptive behavior assessment, administered by a qualified healthcare professional (QHP), face-to-face with the patient, lasting 30 minutes or more.
- 97152: Behavior identification supporting assessment, administered by one technician under the direction of a QHP, face-to-face with the patient, lasting up to 15 minutes.
Treatment and Intervention
- 97153: Adaptive behavior treatment by protocol, administered by a technician under the direction of a qualified healthcare professional (QHP), face-to-face with one patient, each 15 minutes.
- 97154: Group adaptive behavior treatment by protocol, administered by a technician under the direction of a QHP, face-to-face with two or more patients, each 15 minutes.
- 97155: Adaptive behavior treatment with protocol modification administered by QHP, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes.
- 97156: Family adaptive behavior treatment guidance, administered by QHP (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes.
- 97157: Multiple-family group adaptive behavior treatment guidance, administered by QHP (without the patient present), face-to-face with multiple sets of guardians/caregivers, each 15 minutes.
- 97158: Group adaptive behavior treatment with protocol modification, administered by QHP face-to-face with multiple patients, each 15 minutes.
- 0373T: Adaptive behavior treatment with protocol modification, each 15 minutes of technicians’ time face-to-face with a patient, requiring the following components:
- Administered by the QHP who is on site.
- With the assistance of two or more technicians.
- For a patient who exhibits destructive behavior.
- Completed in an environment that is customized to the patient’s behavior.
ABA Modifiers
Modifiers are a critical component of accurately documenting ABA therapy services and ensuring appropriate claims payment. For ABA therapy, the most common modifiers are used to indicate the qualifications of the staff delivering the services. For example, the modifier HN indicates the service was delivered by a clinician with a bachelor’s level degree like an RBT or BCaBA, whereas HO indicates a master’s level degree and HP indicates a doctoral degree. These modifiers can affect reimbursement rates so double-check for accuracy. In this case, billing without a modifier will assume that a BCBA delivered services.
Navigating the Complexities
Insurance companies, Medicaid, and other funding sources periodically review billing documentation to ensure compliance and accuracy, so it’s important to double-check your work to avoid audits and/or claim denials. Understanding ABA Therapy CPT codes can initially seem overwhelming, but with proper training and resources, practitioners can navigate this process effectively. In addition, it’s essential to stay up-to-date with the latest revisions and guidelines provided by the AMA. Professional organizations, billing specialists, and consultants can also serve as valuable sources of guidance and support.
WebABA provides expert billing help, keeping providers updated to maximize reimbursement. Schedule a demo today.
Maximizing Billing and Reimbursement
Accurate coding is just one aspect of successful billing and reimbursement. It is essential to maintain thorough and detailed documentation, including treatment plans, progress notes, and session summaries. Regular staff training on coding procedures and ongoing communication with insurance providers can help address any potential issues or denials promptly. By ensuring timely submission of claims and maintaining clear records, practitioners can maximize reimbursement for their services, supporting their financial sustainability and continued provision of high-quality care.
More Resources
For more information on ABA billing, download our free ABA Billing 101 e-books on Claims Processing, Management of Your Revenue Cycle and Credentialing, Contracting, and RCM KPIs.
If managing billing has become too much to handle, or you need a way to streamline all billing information and tools, schedule a demo of WebABA today. Our software is specifically designed to help alleviate ABA providers of administrative burdens, so that you can focus on care.
