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"Understanding the Latest ABA Therapy CPT Codes for 2023"


Introduction:

ABA Therapy (Applied Behavior Analysis Therapy) is a type of therapy that helps individuals with autism spectrum disorder (ASD) to develop and improve their social, communication, and behavioral skills. Correctly utilizing ABA therapy CPT codes is key for successful billing and reimbursement. The American Medical Association (AMA) established temporary Category III codes for ABA services in 2014, and in 2019, new Category I CPT codes were introduced. In this blog post, we will explore the newest ABA Therapy CPT codes and their categories.


Category I ABA Therapy CPT Codes:

Category I codes are permanent codes that are used to report medical services and to bill insurance providers. The following are the newest Category I ABA Therapy CPT codes:


- 97151: Behavior Identification Assessment

- 97152: Behavior Identification Supporting Assessment

- 97153: Adaptive Behavior Treatment by Protocol, administered by technician under the direction of a BCBA or other qualified healthcare professional

- 97154: Group Adaptive Behavior Treatment by Protocol, administered by technician under the direction of a BCBA or other qualified healthcare professional

- 97155: Family Adaptive Behavior Treatment Guidance, administered by technician under the direction of a BCBA or other qualified healthcare professional


Category III ABA Therapy CPT Codes:

Category III codes are temporary codes that are used to report emerging technologies, services, and procedures. The following are some of the Category III ABA Therapy CPT codes:


- 0359T: Adaptive behavior treatment by protocol, administered by technician under the direction of a BCBA or other qualified healthcare professional

- 0360T: Adaptive behavior treatment with protocol modification, administered by technician under the direction of a BCBA or other qualified healthcare professional

- 0361T: Adaptive behavior treatment with protocol modification, administered by technician under the direction of a BCBA or other qualified healthcare professional, each additional 30 minutes

- 0364T: Group adaptive behavior treatment by protocol, administered by technician under the direction of a BCBA or other qualified healthcare professional

- 0365T: Group adaptive behavior treatment with protocol modification, administered by technician under the direction of a BCBA or other qualified healthcare professional

- 0366T: Group adaptive behavior treatment with protocol modification, administered by technician under the direction of a BCBA or other qualified healthcare professional, each additional 30 minutes

- 0368T: Family adaptive behavior treatment guidance, administered by technician under the direction of a BCBA or other qualified healthcare professional

- 0369T: Family adaptive behavior treatment guidance, administered by technician under the direction of a BCBA or other qualified healthcare professional, each additional 30 minutes


Conclusion:

Correctly utilizing ABA therapy CPT codes is essential for successful billing and reimbursement. The newest Category I ABA Therapy CPT codes include five codes that cover behavior identification assessment, adaptive behavior treatment, group adaptive behavior treatment, and family adaptive behavior treatment guidance. The Category III codes are temporary codes that cover emerging technologies, services, and procedures. It is important to understand the differences between Category I and Category III codes and to use them correctly to ensure accurate billing.





References:


American Medical Association. (2023, August 31). 2023 ABA Therapy CPT Codes. Retrieved from https://therapybrands.com/blog/2023-aba-therapy-cpt-codes/


Autism Speaks. (2018, November 1). New CPT Codes for ABA Billing. Retrieved from https://www.autismspeaks.org/advocacy-news/new-cpt-codes-aba-billing


CodeMetro. (2018, November 11). ABA Therapy Billing and CPT Codes. Retrieved from https://codemetro.com/aba-therapy-cpt-code/


Evernorth Provider. (2020, December 1). Billing Codes for Applied Behavior Analysis. Retrieved from https://static.evernorth.com/assets/evernorth/provider/resourceLibrary/behavioralResources/doingBusinessWithUs/cbhDBwCBillingCodesForABA.html


Neolytix. (2023, March 8). Adaptive Behavior Services Medical Billing and Coding Guide for 2023. Retrieved from https://neolytix.com/adaptive-behavior-services-medical-billing-and-coding/


Rethink Behavioral Health. (2018, November 6). New Category 1 CPT Codes for ABA Services. Retrieved from https://www.rethinkbehavioralhealth.com/resources/new-category-1-cpt-codes-aba-services/


WebABA. (2017, May 17). Understanding ABA Therapy Billing and CPT Codes. Retrieved from https://webaba.com/aba-therapy-cpt-codes/


Your Missing Piece. (2021, August 30). ABA Therapy Billing Codes. Retrieved from https://yourmissingpiece.com/blog/aba-therapy-billing-codes/



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