Navigating the billing process for Applied Behavior Analysis (ABA) therapy can be complex, especially with the numerous CPT codes practitioners must understand and apply. This guide breaks down the key CPT codes for 2024, offering detailed descriptions of each code to help ensure accurate billing and maximize reimbursement.

What are CPT Codes?

Current Procedural Terminology (CPT) codes are standardized codes used to describe medical, surgical, and diagnostic services. For ABA therapy, these codes are critical for communicating the services provided to insurance companies, facilitating accurate billing and timely reimbursement.

2024 ABA CPT Codes

CPT codes for ABA therapy are categorized into two main sections: Category I and Category III. Below is a breakdown of these codes along with their descriptions.

Category I Codes (97151-97158)

These codes represent established and recognized ABA services, such as assessments, individual and group interventions, and family-based interventions. Notably, codes 97155-97157 have been updated to allow for telehealth billing.

• 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).
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• 97152 | Behavior Identification Assessment: Support assessment performed by a technician under qualified healthcare professional supervision (15-minute units). Commonly billed alongside 97151.
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• 97153 | Adaptive Behavior Treatment Protocol: 15-minute unit face-to-face adaptive behavior treatment sessions delivered by a technician under supervision of a qualified healthcare professional (QHP) after the initial evaluation.
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• 97154 | Group Adaptive Behavior Treatment Protocol: In-person therapy for multiple patients to foster social interaction and peer learning (15-minute units).
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• 97155 | Adaptive Behavior Treatment with Protocol Modification: This treatment is administered by a physician or other qualified health care professional, face-to-face with one patient, for each 15-minute session.
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• 97156 | Family Adaptive Behavior Treatment Guidance: 15-minute unit family therapy aimed at teaching skills to support the client’s treatment plan at home (with or without the patient present). Now applicable for telehealth services.
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• 97157 | Multiple Family Group Adaptive Behavior Treatment Guidance: In-person sessions with multiple groups of guardians or caregivers (without the patient present), encouraging sharing experiences and strategies in a supportive environment (15-minute units). Now available for telehealth services.
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• 97158 | Group Adaptive Behavior Treatment Protocol: Group therapy sessions for clients with similar needs, providing peer interactions under professional supervision (15-minute units).

Category III Codes (0362T, 0373T)

These codes address more specific ABA services, including the assessment of adaptive behavior and technician-delivered treatment with protocol modifications.

• 0362T | Exposure Behavioral Follow-Up Assessment: Evaluation for clients exhibiting destructive behaviors, requiring multiple technicians (at least two) working directly with the patient (face-to-face) in 15-minute increments. Supervised on-site by a qualified healthcare professional in a tailored environment.
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• 0373T | Adaptive Behavior Treatment with Protocol Modification: Two or more technicians, under the direction of an on–site physician or other qualified healthcare professional, administer adaptive behavior treatment with modifications in protocol for a patient with severe destructive behaviors, such as, self–injurious behavior. Use this code for each 15 minutes of face–to–face time that the technician(s) spends with the patient.

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).
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• Supervision Requirements: Codes for telehealth interventions still require supervision by a qualified healthcare professional (97156 & 97157).

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, practice management software (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

It is imperative to check verification of benefits, with an understanding if there is a pre-determination or prior authorization required before treatment begins. 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-day 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.

AlohaABA’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 AlohaABA free for 30 days to see how it can help. Additionally, our managed billing services can further streamline your billing processes and ensure your practice gets paid accurately and on time.