Below is a list of the CPT codes accessible in the EI-Hub
that are typically utilized for ABA services. We recommend referring to this
list when preparing 837P files to mitigate rejections due to CPT code. We also
recommend sharing this information with your claims vendor to facilitate any
necessary modifications to their system.
CPT/HCPCS
code
|
Description
|
97153
|
Adaptive behavior treatment by protocol, administered by technician
under the direction of a physician or other qualified health care
professional, face-to-face with one patient; each 15 minutes.
Adaptive behavior treatment codes 97154, 97155, 97158 describe services
that address specific treatment targets and goals based on results of
previous assessments [see 97151, 97152] and include ongoing assessment and
adjustment of treatment protocols, targets, and goals.
|
97154
|
Group adaptive behavior treatment by protocol, administered by
technician under the direction of a physician or other qualified health care
professional, face-to-face with two or more patients, each 15 minutes.
Do not report
97154 with 90785-90899, 92508, 96105-96171, 97150.
|
97155
|
Adaptive behavior treatment with protocol modification administered by
physician or other qualified health care professional, which may include
simultaneous direction of technician, face-to-face with one patient, each 15
minutes.
Do not report with 90785-90899, 92507, 96105-96171, 97150.
|
97158
|
Group adaptive behavior treatment with protocol modification,
administered by physician or other qualified health care professional
face-to-face with multiple patients, each 15 minutes.
Do not report
with 90785-90899, 96105-96171, 92508, 97150.
|
It’s important to note that codes are updated yearly by the
American Medical Association (AMA); therefore, the listing above is subject to
change.
Article ID: 495, Created On: 5/31/2024, Modified: 10/1/2024