If you embarked on this specialization thinking that medical coding and billing for Applied Behavior Analysis (ABA) therapy would be fast and easy, let us set the record straight. It definitely is NOT!
In fact, billing ABA therapy services can be harder than conventional medical specialties like OB/GYN and cardiology because evaluation and treatment are based on the science of learning and human behavior – Both are non-static and nuanced. Therefore, an annual revision of the CPT codes for ABA therapy becomes necessary.
Let’s analyze the common ABA therapy CPT codes for 2024 and the coding best practices to ensure accurate reimbursements for ABA therapies.
Common ABA Therapy CPT Codes 2024
The Current Procedural Terminology (CPT) code sets are copyrighted by the American Medical Association (AMA) and are used to standardize the billing of healthcare procedures and services.
ABA therapists must assign accurate CPT codes for services, such as patient assessments and treatments, to collect reimbursements from insurance payers. Non-compliance with the most recent ABA therapy CPT coding guidelines can result in claim denials and lost revenue.
The commonly used CPT codes for ABA therapy are as follows.
ABA Therapy CPT Codes for Evaluation & Assessment
CPT Code 97151 – Initial Behavior Identification Assessment
It is one of the most important CPT codes for ABA therapy. Providers assign this code when they bill 15 minutes of the initial face-to-face assessment of a patient’s adaptive or maladaptive behavior.
The provider performs different types of tests, gives scores, interprets the results, develops a treatment plan, generates a report, and talks to the patient’s parent/ guardian/ caregiver to convey the details of the ABA program.
CPT Code 97152 – Observational Behavior Follow-up Assessment
ABA therapies or programs involve ongoing assessments to monitor the patient’s gradual progress. Hence, another commonly used ABA therapy CPT code for evaluation and assessment is 97152.
Mental health specialists report this code when they seek reimbursements for 15 minutes of face-to-face time with the patient. In this short session, the provider performs a supporting assessment of the patient’s destructive behavior and identifies behavioral problems by directly interacting with the patient.
CPT Code 0362T – Exposure Behavioral Follow-up Assessment
This ABA therapy CPT code is used to bill a face-to-face follow-up assessment of at least 15 minutes.
During this visit, an on-site licensed mental health provider (ABA therapist) assesses and follows up on the patient’s maladaptive destructive behavior. The interpretation is reported, and directives are issued.
ABA Therapy CPT Codes for Intervention & Treatment
CPT Code 97153 – Adaptive Behavior Treatment by Protocol
The 97153 ABA therapy CPT code focuses on behavioral treatments for developmental disabilities, such as poor social skills and communication. Providers use this code when they bill 15 minutes of a technician’s face-to-face interaction with ONE patient.
In this adaptive behavior procedure, the provider administers treatments that target conditions linked to adaptive or maladaptive behaviors as per the established protocol.
CPT Code 97154 – Group Adaptive Behavior Treatment by Protocol
A common CPT code for ABA therapy in group settings is 97154. This code is reported when a technician, under the guidance of a licensed mental health provider, delivers a face-to-face service to TWO or more patients.
The code indicates that a technician administered adaptive behavior treatments to cure conditions, such as developmental disabilities, arising from adaptive or maladaptive behaviors in line with the established protocols.
CPT Code 97155 – Adaptive Behavior Treatment with Protocol Modification
The CPT code 97155 for ABA therapy indicates that during the direct treatment, the authorized mental health specialist was also teaching techniques to a technician in attendance.
A provider uses this code to report 15 minutes of face-to-face adaptive behavior treatment with ONE patient, where modifications were made in the protocol and ABA techniques to assist the technician’s learning.
CPT Code 97156 – Family Adaptive Behavior Treatment Guidance
The ABA therapy CPT code 97156 is used to specify the family’s involvement in the ABA treatment procedures. When the provider meets the patient’s parent/ guardian/ caregiver for 15 minutes (in person) to discuss the adaptive behavior treatment, in the patient’s presence or absence, this code is used to bill that encounter.
During these 15 minutes, the family receives training and guidance to optimize the results of the patient’s treatment plan.
CPT Code 97157 – Multiple-Family Group Adaptive Behavior Treatment Guidance
In their battle with developmental disorders, neurodivergent patients and their families need the community’s support the most. Hearing the experiences of other families who are managing their loved ones’ disorders (autism, ADHD, or dyslexia) can comfort the parent or caregiver and enhance the treatment’s results.
97157 CPT code for ABA therapy is used especially for that. It denotes the 15 minutes a provider spends face-to-face with a group of parents or caregivers to discuss multiple patients’ adaptive behavior treatments in their absence.
CPT Code 97158 – Adaptive Behavior Treatment Social Skills Group
Another CPT code for ABA therapy in a group setting is 97158. This code is reported when the provider performs adaptive behavior treatment on multiple patients enrolled in a social skills group.
Every 15 minutes the provider spends in person with this group is billed using CPT code 97158.
CPT Code 0373T – Adaptive Behavior Treatment with Protocol Modification
If you were looking for the ultimate life-saving ABA therapy CPT code, 0373T is just that. When 2 or more technicians spend 15 minutes with a patient with seriously destructive behaviors, such as self-harm, under the guidance of an on-site ABA therapist, then this code is used to bill the procedure.
During this face-to-face encounter, technicians and qualified mental health providers administer adaptive behavior treatment with modifications in the protocol. The procedure must also be completed in an environment that suits the patient’s severely destructive behavior.
ABA Therapy Coding Best Practices
Medical coding and billing for ABA therapy can be a long and complicated process, especially if you fail to implement the coding best practices. Inefficiencies and inaccuracies in the ABA therapy medical billing and coding workflow can lead to claim denials, resulting in missed opportunities for revenue collection.
So, when it is already taking a lot to keep your applied behavior analysis (ABA) practice afloat, don’t let coding mistakes drown it. Do this instead.
Follow Revised Coding Guidelines
We have mentioned before that the AMA updates its CPT code sets every year. It can be a real challenge to tally dozens of CPT codes for ABA therapy and ensure that the ones you use are valid and accurately specify the service or procedure you wish to bill. Medical claim denial rates due to incorrect or outdated CPT codes are high.
Therefore, a good practice would be to stick to the most recent coding guidelines and double-check each ABA therapy CPT code before claim submission.
Educate and Train Staff
Many healthcare providers delegate medical coding and billing to their most junior resources, such as trainee nurses and physicians. Although unfortunate, it is a common practice that jeopardizes rightful and timely payment collections.
If you prefer to let your staff handle the coding for ABA therapy services, then at least invest in their regular training. Review the revised coding guidelines with them and teach them the intricacies of medical billing.
Use Modifiers Where Needed
Incorrect or missing modifiers are another common cause for claim denials. Use modifiers when needed to offer more explanation for an ABA therapy service. The commonly used modifiers for ABA therapy for Medicaid patients are:
- HO – specifies that the ABA therapist has a master’s degree in a related field, such as psychology, social work, or counseling.
- HP – specifies that the mental health professional is a clinical psychologist or has a doctorate (PhD) in a related field.
Outsource ABA Therapy Billing
It is not easy to work with mentally challenged individuals all day and spend your nights navigating the complex medical billing processes. You need a break. But more than that, you need an ABA therapy billing partner that you can count on.
Outsourcing ABA therapy billing services requires a small investment, but the benefits are huge. You get instant access to AAPC-certified coders experienced in your specialty. They use the correct ABA therapy CPT codes to guarantee clean claims submission.
Bottom Line
There are numerous CPT codes for ABA therapy, but your journey to full and faster reimbursements hinges on their correct usage.
Now that you know the common ABA therapy CPT codes for 2024 and the best practices for coding ABA therapies, apply them as needed to secure reimbursements for your carefully administered treatments and patient assessments.
