Billing Codes for the Assessment and Treatment of Destructive Behavior
A major barrier to helping individuals with severe destructive behavior has been the absence of Current Procedural Terminology (CPT®) codes that behavior analysts can use to bill for services. The CPT codes are numerical codes that qualified healthcare professionals use to identify medical services and procedures. These codes provide a standardized mechanism for qualified healthcare professionals to communicate with third-party payors about the services and procedures they planned to or did provide to a patient.
The establishment of CPT codes for ABA services by the AMA, called adaptive behavior services, has led or will, over time, lead to a number of potential benefits for patients who require and providers who deliver such services, including: (a) recognition by the AMA that ABA procedures are medically necessary under appropriate circumstances; (b) reduced insurance denials and the associated financial burden to families; (c) increased access to ABA services because CPT codes form the basis for Medicaid, Medicare, and insurance benefit packages.
The ABA Services Workgroup Group submitted a change-code proposal in October of 2016, and the CPT Editorial Panel reviewed and approved the revised adaptive behavior codes in February 2017. The panel approved eight codes as permanent, Category I CPT codes and two codes as revised Category III codes. The codes refer to qualified healthcare professionals, which are often board-certified behavior analysts (BCBA) and to technicians, which are typically registered behavior technicians (RBT). Qualified healthcare professionals bill these codes in 15-minute units.
Permanent, Category I Codes
Below is a list of permanent, category I billing codes. Click each code to learn more.
- Behavior-Identification Assessment (97151)
- Behavior Identification Supporting Assessment (97152)
- Adaptive Behavior Treatment by Protocol (97153)
- Group Adaptive Treatment by Protocol (97154)
- Adaptive Behavior Treatment with Protocol Modification (97155)
- Family Adaptive Behavior Treatment Guidance (97156)
- Multiple-Family Group Adaptive Behavior Treatment Guidance (97157)
- Group Adaptive Behavior Treatment with Protocol Modification (97158)
Temporary, Category III Codes
All the adaptive behavior codes require prior authorization from insurance companies prior to delivering the service. However, prior authorization, combined with rate negotiation, is particularly important for Category III codes, which are temporary codes. Insurance companies may be more reluctant to negotiate higher rates for Category III codes due to their temporary status. Click each code below to learn more.
Using Billing Codes
Click the links below to learn about how to use certain billing codes.
- Using the Behavior-Identification Assessment Code for Destructive Behavior
- Using the Behavior-Identification Supporting-Assessment Code for Destructive Behavior
- Using the Adaptive-Behavior Treatment by Protocol Code for Destructive Behavior
- Using the Family-Adaptive Behavior-Treatment Guidance Code for Destructive Behavior
- Using Adaptive Behavior Codes for Follow-Up Treatment of Destructive Behavior
