ABA Billing Codes Cheat Sheet & Best Practices 

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ABA Billing Codes

When health insurance and government programs first acknowledged Applied Behavior Analysis (ABA) as a medically necessary treatment, there weren’t billing codes specific to ABA. As a result, ABA therapists and billers would have to use generic billing codes to file ABA claims.  

This brought confusion and inconsistency to the claims process, sometimes causing denials. The Association for Behavior Analysis International (ABAI) requested the CPT Editorial Panel to amend billing codes to standardize ABA billing in 2012. Consequently, new CPT I and CPT III codes took effect in 2019 to help prove the medical necessity of various ABA treatments and harmonize billing. Here we are today, in 2024, where ABA billing codes were updated once again to allow billing for telehealth services, and to include more accurate descriptions for their usage. We list these further in the blog. As you can see, updates continue to be made to ensure the standardization of ABA billing, so stay tuned as more updates are sure to come.  

Today, there are several CPT codes that guide ABA therapy billing. However, many ABA therapists still face challenges due to code complexity and claims processing issues. Let’s explore how these problems cause hiccups in ABA billing and insurance claims (and what you can do to make your billing workflows easier). 

ABA Billing Code Complexity 

After completing ABA services, your practice needs to file your claims correctly. This requires accurate coding of each claim with the correct CPT code to ensure approval and payment. Whether your practice bills by hand, Excel, billing software, or utilizes an outside billing team, coding therapy sessions appropriately is essential. 

However, ABA billing codes are intricate and specific, so you (or your billing team) must have an in-depth understanding of the system. Here are some reasons that complicate claims processing when dealing with health insurance companies and government programs. 

Continuously Changing CPT Codes 

One reason why medical professionals like ABA therapists have trouble with billing is the emergence of new codes. Codes change from time to time due to healthcare regulations, among other reasons.  

As a result, keeping up with the latest CPT system can be tricky. It’s primarily a problem for newer billing professionals and solo practitioners or small practices where therapists bill for themselves in their downtime. 

If your practice has an outdated coding list, you might end up entering the wrong diagnostic codes, treatment codes, or billing codes. Any of these errors can lead to the insurance company denying a client’s claim. 

Your practice can overcome this challenge by training your team or billing personnel on the latest billing codes and trends. Staying on top of the current ABA billing codes, guidelines, and procedures will keep your staff ahead of the curve. 

Many ABA practices avoid billing headaches by working with an outside managed billing team that provides revenue cycle management services. (WebABA has a dedicated team of ABA billing experts if your practice could benefit from the help.) 

2024 ABA CPT Codes

CPT codes categorize ABA billing into two main sections: Category I and Category III.

  • Category I Codes (97151-97158): These codes represent established and recognized ABA services like assessments, individual and group interventions, and family-based interventions. To note: codes 97155-97157 have been updated to allow for telehealth billing.
  • Category III Codes (0362T, 0373T): These codes address more specific ABA services, such as assessment of adaptive behavior (0362T) and technician-delivered treatment with protocol modifications (0373T).

Adaptive Behavior Assessment  – Category I Codes

CPT CodeDescription
97151
Behavior Identification Assessment
Covers the initial in-depth evaluation to identify a client’s specific needs and develop a treatment plan, administered by a physician or other qualified healthcare professionals (15-minute units).
97152
Behavior Identification Assessment
Behavior identification support assessment by technician (15-minute units). While similar to 97151, this is used when a technician performs supportive assessment under qualified healthcare professional supervision. It’s common for 97152 and 97151 to be billed together

Adaptive Behavior Assessment – Category III Code

CPT CodeDescription
0362T
Exposure Behavioral Follow-Up Assessment
This is for the evaluation of clients that exhibit destructive behaviors. The session involves multiple technicians (at least two) working directly with the patient (face-to-face) in 15-minute increments. A qualified healthcare professional (QHP) supervises the session on-site, and the environment is specifically tailored to address the patient’s behavior (to ensure the safety for all involved).

Adaptive Behavior Treatment – Category I Codes

CPT CodeDescription
97153
Adaptive Behavior Treatment Protocol
Used to report 15-minute unit face-to-face adaptive behavior treatment sessions delivered by a technician under the supervision of a qualified healthcare professional (QHP) after the initial in-depth evaluation.
97154
Group Adaptive Behavior Treatment Protocol
Used to report 15-minute unit in-person therapy involving multiple patients, creating a supportive group environment that encourages social interaction and peer learning.
97155
Adaptive Behavior Treatment with Protocol Modification
This code is used for individual therapy sessions that concentrate on implementing and customizing the ABA treatment plan (15-minute units). It is used when an authorized ABA supervisor or assistant behavior analyst addresses issues with a protocol, such as assessing progress, making adjustments, or testing skills. This code can now be used for telehealth services as well.
97156
Family Adaptive Behavior Treatment Guidance
Represents 15-minute unit in-person family therapy aimed at teaching family members skills to support the client’s treatment plan at home (with or without the patient present). This code can now be used for telehealth services as well.
97157
Multiple Family Group Adaptive Behavior Treatment Guidance
Includes in-person sessions with multiple groups of guardians or caregivers (without the patient present), allowing them to share experiences and strategies in a supportive environment (15-minute units). This code can now be used for telehealth services as well.
97158
Group Adaptive Behavior Treatment Protocol
This code represents group therapy sessions for clients with similar needs, providing peer interactions under professional supervision (15-minute units).

Adaptive Behavior Treatment – Category III Code

CPT CodeDescription
0373T
Adaptive Behavior Treatment with Protocol Modification
This code applies to treatment delivered by a single technician following a pre-determined protocol. The protocol is established by the BCBA based on the patient’s needs. Unlike 0362T, this code doesn’t involve destructive behaviors or require a specialized environment.

Important Considerations about CPT Codes Now Covering Telehealth Services:

  • Telehealth Modalities: These codes are typically used for live video conferencing with the patient. Audio-only telehealth for ABA services might have limited to no coverage depending on the payer (insurance company).
  • Supervision Requirements: Codes for telehealth interventions still require supervision by a qualified healthcare professional (97156 & 97157).

ABA Billing Procedural Issues 

Even with a thorough understanding of ABA billing codes, you can still have trouble with health insurance companies because of in-house billing issues. Below are some mistakes that can increase the risk of claim delays and denials in an ABA practice. 

Entering Client Information Incorrectly 

Incorrect data entry and typing errors are a reality for many medical offices and ABA therapy practices. For instance, you can misspell a patient’s name or make a typo in the date of birth or policy number. 

Insurance companies can deny claims due to even the most superficial errors in client identification information. So, even if you’re in a rush, it’s in your best interest to ensure that all client details are correct. Teach your staff the importance of accuracy and proofreading to reduce errors in claims. 

Failure to Confirm Eligibility 

ABA therapy coverage can vary with insurance companies. Clients and their families/caregivers might not have all the details about their coverage. They might think that their insurance will cover all aspects of ABA treatment, or they might be unaware of carve-outs. 

The health plan can surprise you with rejection if you file claims without verifying a patient’s insurance coverage. This is where eligibility checks and prior authorization management are key to your practice’s financial health and operational workflows.   

As a rule of thumb, be sure to confirm your patient’s insurance coverage during the scheduling process. If you don’t have prior authorization management in your practice’s software, be sure to monitor it through other means. It will save you the trouble of chasing payments or losing revenue. Learn about how WebABA’s eligibility check and prior authorization features help avoid unnecessary rejections and streamline your billing processes.

Not Seeking Referral Authorization 

Specialty services providers like ABA therapists get a significant number of clients from referrals. Typically, it happens when a physician or another health care provider feels that therapy is necessary for better patient outcomes. 

Most payers expect you to inform them before offering services to a referral under a given plan. The terms may vary with insurance carriers, so it’s best to understand referral policies for various health plans. Before submitting a claim to an insurance company, be sure to include all the relevant referral information. 

Sloppy Handwriting and Documentation 

Many professionals in the medical field are known for illegible handwriting. A payer can reject a messy claim even if you know your CPT codes and have included all the supporting documentation. 

If your data entry personnel cannot read your clinical notes, they might misinterpret the information or even enter the wrong billing codes. Besides denying your claim, a payer can ask for additional details or require you to resend new documentation. It leads to income loss or interruptions in your revenue stream. Pro tip: this becomes less of an issue if you have digital SOAP notes or data collection tools

Duplicate Record Generation 

Another ABA billing mistake emanating from human error is duplicate billing. It usually happens when the billing specialist accidentally submits a claim more than once. It can result in claim denials or delays as you sort the matter out with the patient’s insurance company. 

Additionally, filing a claim for a canceled therapy session is a common billing error. You can eliminate it by implementing an ABA practice management system that facilitates proper, accurate services coding. It helps you capture potential duplicates and erroneous entries before submitting claims to insurers. 

Missing the Deadline for Claim Submission 

Most health insurance companies have strict time frames within which you must submit a claim for services provided. A payer can deny an accurate and properly documented claim if you fail to file it before the deadline. 

Medicaid offers a window of up to one calendar year to file claims on your patients’ behalf. On the other hand, most private insurance carriers require you to submit claims within 60 to 90 days from the day of service. Be sure to check the deadline window with the health plans you deal with to avoid surprises. 

Tips to Avoid ABA Claim Rejection

Keeping up with ABA billing codes and preparing accurate health insurance billing is no easy feat. Besides CPT codes being hard to master, they keep on changing over the years. 

Simple clerical errors like making wrong entries or submitting illegible documentation can lead to a patient’s insurance denying a claim. The result is delayed payment or lost revenue. 

If you would like to improve the accuracy and efficiency of your ABA billing system, use the following tips. 

Learn How to Submit Claims 

Once you’ve prepared a well-documented claim, you need to send it to the payer on paper or electronically. Ensure you have the correct mailing address or submit a soft copy through your electronic health record (EHR) system, pms/clearinghouse, or insurer’s website. 

Confirm Your Client’s Demographic Information 

Apart from the client’s name, some of their demographic details like age and gender are necessary to complete a claim form. Double-check your client’s data to avoid errors that could lead to a claim denial or delay.  

Confirm the Client’s Coverage Eligibility 

Before submitting claims, check the client’s insurance policy status to determine their eligibility for coverage. It will save you the disappointment of a claim denial due to a client having exhausted their coverage cap. 

Keep a Duplicate of the Client’s Insurance Card 

Sometimes you’ll need to verify vital details like a client’s insurance number. Instead of calling them, make a copy of their insurance card for your review when needed. If you have practice management software, their info should be stored in your digital records for easy access. 

Watch Out for Claim Submission Deadlines 

Most health insurance companies offer a 60 to 90-days allowance for claim submission. Confirm the deadline for various providers and file your claims on time. If a claim is denied and your practice must resubmit, be aware of any deadlines for this process as well. 

Use Automated Billing Software

While the tips above can help minimize errors and ensure smoother claim submissions, consider incorporating automated billing software into your ABA practice. This software reduces errors, improves efficiency, speeds up reimbursements, enhances claim tracking, and offers integrated reporting. It can significantly enhance your billing accuracy, efficiency, and overall financial health.

WebABA’s comprehensive practice management software includes automated billing that integrates directly with other areas of your practice, such as scheduling, documentation, and session notes. If you want to improve your practice’s billing process, try WebABA for free to see how it can help.

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