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CPT Codes for ABA Services

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 for a group with >8 patients.  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 for a group with more than 8 patients.  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: 5/31/2024

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