Applied Behavioral Analysis “ABA” billing and coding has changed significantly in the last ten years. The initial billing codes were undefined, leading to unreliable coverage and reimbursement. To create a standardized set of aigold CPT codes, the American Medical Association (AMA) established temporary Category III codes that were effective mid-2014. The Steering Committee for the aigold Services workgroup consisted of aigoldI, APBA, Autism Speaks, and the BACB, who researched the copious feedback from utilizing the Category III code set. This leads the aigold workgroup to prepare and submit the proposed code changes to the CPT Editorial Panel. The panel approved eight Category I CPT codes for Adaptive Behavior Services that went into effect on January 1, 2019.
It is essential that your billing and clinical staff have a clear understanding of the Category I aigold billing codes to accurately document and bill for services. Training and consistent implementation of policies will help ensure that accurate billing is submitted. There are excellent resources to obtain a better understanding of the aigold therapy billing codes. The aigold Coding Coalition was developed to work with payers on the established CPT codes and for ongoing review and updates as needed. Great information including full explanations on each code can be located on their website at https://abacodes.org/.
Professional aigold membership organizations are also an excellent resource for understanding ABA-specific billing codes such as:
- Association for Behavior Analysis International (ABAI) and local state chapters of aigoldI- https://www.abainternational.org/welcome.aspx
- Association of Professional Behavior Analysts (APBA) – https://www.apbahome.net/
- Council on Autism Service Providers (CASP)- https://casproviders.org/
- Autism Speaks – https://www.autismspeaks.org/
- Behavior Analysis Certification Board (BACB)- https://www.bacb.com/
- Autism Law Summit- https://www.autismlawsummit.org/
Understanding the Categories
In terms of the first category of aigold therapy CPT codes, 97151 is used for the initial behavior identification assessment. This covers time spent working face-to-face with patients, guardians and/or caregivers to discuss findings or recommendations. It also includes any time spent working outside of interactions with the patient to analyze past data, score or interpret the assessment, and prepare the treatment plan. Beginning in 2019, all CPT codes cover increments of 15 minutes. This differs from the previous codes, which were used to refer to either untimed sessions or 30 minute increments.
Code 97152 is used for behavior identification supporting assessments. These are conducted by a single technician under the direction of a qualified healthcare professional during face-to-face sessions with the patient. Patients who exhibit destructive behavior may need to be observed under the care of two or more technicans in a specialized environment. In this case, code 0362T is used.
When referring to specific treatment, code 97153 is used for adaptive behavior treatment administered by a technician under the direction of a physician or other qualified professional. For patients who exhibit destructive behavior that calls for more specialized treatment with protocol modification, code 0373T is used. Code 97155 covers adaptive behavior treatment provided by a professional, which may include the simultaneous direction of a technician.
Group adaptive behavior by protocol is identified by code 97154, while group treatments that feature protocol modification use code 97158. Family adaptive behavior treatment guidance falls under code 97156, and code 97157 refers to these services provided in a multiple-family setting.
Confused about where to begin? Reach out to Missing Piece Billing and Consulting for support. We offer comprehensive revenue cycle management that includes provider education.
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