ABA Therapy: Managing Autism Spectrum Disorders (ASD) can be challenging, but Applied Behavior Analysis (ABA) therapy has proven to be effective in improving social, communication, and behavioral skills. Although often recommended for children with ASD, adults can also benefit from this specialized treatment.
Healthcare providers and insurance companies need to be familiar with the correct Current Procedural Terminology (CPT) codes for ABA therapy. These codes are used to accurately describe medical, surgical, and diagnostic services across the healthcare industry. Proper use of CPT codes helps streamline the documentation of patient treatments and services, minimizes billing errors, and ensures that healthcare organizations receive appropriate reimbursement.
Updated CPT Codes for ABA Therapy in 2024
In 2024, new updates to the ABA therapy CPT codes have been released. These updates provide more accurate descriptions of the services rendered during ABA therapy sessions. Some of the key ABA codes for 2024 include:
ABA therapy primarily utilizes two categories of CPT codes:
- Category I: For widely used medical procedures or services.
- Category III: For emerging medical technologies, procedures, or services, reflecting the innovative and evolving nature of ABA therapy.
Each CPT code, comprising five characters, uniquely identifies specific therapeutic activities, making it easier for practitioners to bill for their services accurately.
Adaptive Behavior Assessment Codes
These codes are intended to document and bill for the initial and ongoing assessments that are essential for developing and modifying personalized treatment plans for clients.
Category I
| CPT Code | Description |
| 97151 | This code refers to the assessment of adaptive behavior, a key step in creating a personalized treatment plan for patients with ASD. |
| 97152 | This code is applied to the treatment of adaptive behavior, encompassing the implementation of behavior intervention strategies. |
Adaptive Behavior Treatment Codes
These codes cover a range of treatment approaches in ABA therapy, including individual sessions, group therapy, and family interventions.
Category I
| CPT Code | Description |
| 97153 | This code covers behavior identification and assessment procedures, aiding in the diagnosis and understanding of a patient’s behavioral challenges. |
| 97154 | This billing code pertains to behavior recognition assessments, specifically for patients displaying disruptive behavior. Conducted in a controlled setting by a qualified health professional and supported by two or more technicians, these evaluations are carried out with close supervision. Billing is done in 15-minute increments, reflecting the detailed and thorough nature of these assessments. |
| 97155 | This code covers group sessions focused on adaptive behavior treatment, designed to enhance social skills and interactions among multiple participants. |
| 97156 | This code applies to individual adaptive behavior treatment sessions, offering one-on-one therapy customized to meet the specific needs of the patient. |
| 97157 | This code pertains to family adaptive behavior treatment guidance, providing counseling and support to family members to assist in the patient’s progress outside of therapy sessions. |
| 97158 | This code covers caregiver training, aimed at equipping caregivers with the skills and knowledge needed to effectively apply ABA strategies. |
Category III
| CPT Code | Description |
| 0362T | This code covers behavior identification assessments by a technician, supervised by a physician or qualified professional, with assistance from two or more technicians. Conducted face-to-face in a suitable environment, the assessment is billed in 15-minute increments. |
| 0364T | This temporary Category III code is used to report adaptive behavior assessments for individuals with ASD. |
| 0373T | This code addresses adaptive behavioral treatment involving protocol adjustments made by a technician. It includes one-on-one, face-to-face sessions customized to the patient’s specific needs. Treatment plans are updated as needed to reflect changing goals and progress. |
The new ABA therapy CPT codes enable healthcare providers and insurance companies to bill more precisely for ABA therapy services. This improvement helps ensure that individuals with ASD continue to receive the specialized care necessary for their success.
Partnering with Tranquil Med Solutions
If you need a medical billing company to simplify your ABA therapy practice, Tranquil Med Solutions is a great option. They offer flexible services and prioritize excellent customer support.
Make Billing and CPT Code Updates
Keeping up with CPT code updates for ABA therapy can be complex, particularly with recent changes from the American Medical Association (AMA). Make your billing process smoother by partnering with Missing Piece, a specialized ABA therapy billing provider.
Core Components of Adaptive Behavior Services (ABA)
According to the American Medical Association’s CPT codebook, adaptive behavior services focus on:
- Functional behavior assessment involves descriptive methods aimed at identifying environmental factors that precede and follow potential target behaviors, which may influence these behaviors.
- Functional analysis is an evaluation method used to assess the impact of various environmental factors on a potential target behavior. This is done by systematically introducing and removing each factor with a patient multiple times, while observing and measuring the behavior’s response to these changes.
- Standardized instruments and procedures include, but are not limited to, behavior checklists, rating scales, and adaptive skill assessment tools that consist of a set number of items and are administered and scored consistently across all patients (e.g., Pervasive Developmental Disabilities Behavior Inventory, Brigance Inventory of Early Development, Vineland Adaptive Behavior Scales).
- Non-standardized instruments and procedures include, but are not limited to, curriculum-referenced assessments, stimulus preference assessment methods, and other techniques for evaluating behaviors and related environmental factors that are tailored to the individual patient and their specific behaviors.
The “Adaptive Behavior Services Medical Billing and Coding Guide for 2024” will delve into the key differences between adaptive behavior services and other related procedures.
Stay Ahead with Updated CPT Codes for ABA Therapy in 2024
The CPT codes for ABA therapy have been updated for 2024 to better represent the services provided to individuals with autism spectrum disorders (ASD). Accurate billing and reimbursement depend on these updated codes, making them crucial for healthcare professionals and insurance companies.
Utilize the advanced medical billing solutions of Missing Piece to streamline your ABA therapy practice. Our expertise in accurate billing and efficient practice management ensures your operations run smoothly and your patients receive top-quality care.
With over a decade of experience, Missing Piece delivers expert ABA billing services across the US. Our knowledgeable team ensures your billing and reimbursement processes are optimized, providing additional financial support as needed and adapting to your practice’s evolving needs.
FAQ’s
What are the 2024 ABA billing codes?
For adaptive behavior treatment, the relevant CPT codes are 97153, 97155, and 0373T. For group therapy sessions, use codes 97154 or 97158. For family therapy, the appropriate codes are 97156 or 97157. Utilizing these codes ensures accurate and comprehensive billing for various adaptive behavior treatments.
Which CPT codes are used for ABA therapy?
A13: The updated CPT codes are organized into four clusters:
ABA Qualified Health Professional Services: 97155, 97156, 97157, 97158
ABA Behavior Identification Assessments: 97151, 97152
ABA Direct Care Codes: 97153, 97154
ABA Multi-Staff Treatment: 0362T, 0373T
Can you bill 97155 & 97156 together?
97155 & 97156: Concurrent billing is permitted when one authorized ABA supervisor or assistant behavior analyst is delivering services to the beneficiary (CPT code 97155), whether or not a behavior technician is present, while another ABA supervisor or assistant behavior analyst conducts parent or caregiver training (CPT code 97156) without the beneficiary being present.
What is the 2024 CPT code?
In 2024, the CPT Editorial Panel has refined the evaluation and management (E/M) visit codes by removing references to specific time ranges and introducing a minimum time requirement for selecting the E/M service level based on time.
How many new E&M codes were introduced for 2024?
In 2024, the CPT code set features 230 new codes, 49 deletions, and 70 revisions, reflecting advancements in medical science and health technology.
