ABA CPT Codes for Adaptive Behavior Services – Effective January 2019
The temporary ABA CPT codes have come (mostly) to an end at long last. January 1, 2019 marks an important time for the ABA world—the new CPT codes the American Medical Association CPT Editorial Panel released this August will go into effect.
What’s Changing?
The American Medical Association CPT® Editorial Panel has released eight new Category I and two revised Category III (temporary) CPT codes for billing applied behavior analysis (ABA) services. These new codes will replace the temporary Category III codes that have been used by ABA providers to bill for adaptive behavior assessment and treatment services.
The release of these new codes is a result of a process that started in 2013 when a Coding Change Application (CCA) was submitted to the American Medical Association (AMA). This application was submitted in an effort to help combat the inconsistent coding and reimbursement by payers for ABA services.
This application led to the development and release of a set of Category III (temporary) codes that went into effect in July of 2014. Category III codes are temporary codes used by the AMA to collect data on emerging technology, services, and procedures. They also help determine how widespread and heavily used the proposed services are.
After the release of the Category III codes, an ABA Services Work group consisting of ABAI, APBA, Autism Speaks, the BACB, and other stakeholders was formed to help collect feedback regarding the newly released codes. Over the last few years, this working group has conducted various interviews and surveys to collect feedback about the codes and has created a crosswalk to help providers utilize these temporary codes more appropriately.
In 2016, the Steering Committee for the ABA Services Work Group, which comprises representatives of the Association of Professional Behavior Analysts, Association for Behavior Analysis International, Behavior Analyst Certification Board, and Autism Speaks submitted a revised CCA to the CPT Editorial Panel calling for Category I codes for adaptive behavior services to replace the temporary Category III codes of 2014. Category I codes different from Category III codes in that they are permanent numerical codes that are five digits long and can be used with CMS and any other third party payer.
The CPT Editorial Panel approved eight new Category I and two revised Category III (temporary) CPT codes for billing adaptive behavior services in February of 2017. These new codes will go into effect January 1, 2019.
What are the New ABA CPT Codes?
The Category I codes are as follows:
- 97151: Behavior identification assessment, administered by a physician or other qualified healthcare professional, each 15 minutes of the physician’s or other qualified healthcare professional’s time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan.
- 97152: Behavior identification supporting assessment, administered by one technician under the direction of a physician or other qualified healthcare professional, face-to-face with the patient, each 15 minutes.
- 97153: Adaptive behavior treatment by protocol, administered by a technician under the direction of a physician or other qualified healthcare professional, face-to-face with one patient, every 15 minutes.
- 97155: Adaptive behavior treatment with protocol modification, administered by a physician or other qualified healthcare professional, which may include simultaneous direction of a technician, face-to-face with one patient, every 15 minutes.
- 97154: Group adaptive behavior treatment by protocol, administered by a technician under the direction of a physician or other qualified healthcare professional, with two or more patients, every 15 minutes.
- 97158: Group adaptive behavior treatment with protocol modification, administered by a physician or other qualified healthcare professional, face-to-face with multiple patients, every 15 minutes.
- 97156: Family adaptive behavior treatment guidance, administered by a physician or other qualified healthcare professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), every 15 minutes.
- 97157: Multiple-family group adaptive behavior treatment guidance, administered by a physician or other qualified healthcare professional (without the patient present), face-to-face with multiple sets of guardians/caregivers, every 15 minutes.
The revised Category III codes are:
- 0373T: Adaptive behavior treatment with protocol modification, every 15 minutes of technicians’ time face-to-face with a patient, requiring the following components:
- administered by the physician or other qualified healthcare professional 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.
- 0362T: Behavior identification supporting assessment, every 15 minutes of technicians’ time face-to-face with a patient, requiring the following components:
- administered by the physician or other qualified healthcare professional 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.
The BACB has created a crosswalk to show how the newly released ABA codes relate to the older Category III (temporary) codes, you can access it here. As healthcare companies begin to adopt these new codes, it is important to stay up to date about changes as they affect you, your clients, and your practice.
With CodeMetro’s NPAWorks, you will have access to the new CPT codes as soon at they go into effect on January 1, 2019. CodeMetro helps you reduce your billing errors and get paid faster, learn how we can help with your insurance billing.