ABA CPT codes
Applied Behavioral Analysis or ABA CPT codes are used for billing services related to behavior interventions, primarily for individuals with developmental or behavioral challenges, such as autism spectrum disorder (ASD).
Summary
- Applied Behavioral Analysis or ABA CPT codes standardize the documentation and billing process for behavioral interventions, ensuring effective communication between providers, insurers, and government agencies. Enrolling in an insurance billing course for therapists can help providers enhance their knowledge on codes.
- OTs collaborate with ABA professionals to integrate sensory and functional strategies into behavior intervention plans, enhancing self-regulation, executive functioning, and social participation.
- OTs must carefully distinguish between ABA and OT services when billing, ensuring compliance with supervision agreements and payer policies to avoid claim denials and conflicts.
- OTs should remain within their scope of practice, follow evidence-based interventions, and adhere to ethical guidelines when contributing to ABA-focused therapy, ensuring a holistic and functional approach to care.
- By leveraging an EHR like TheraPlatform for efficient documentation and claim submission, therapists can maintain accurate records.
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ABA CPT codes provide a common language for providers and insurers and government agencies to communicate and document interventions.
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These codes facilitate reimbursement for evidence-based intervention strategies to improve socially significant behaviors. Although the codes are primarily associated with behavior analysts, occupational therapists may collaborate in multidisciplinary teams to provide ABA services.
Therefore, understanding ABA CPT codes is a valuable tool for OTs, as it allows them to ensure appropriate billing and documentation and appropriately advocate for their role in an interdisciplinary team.
Overview of ABA CPT codes
ABA CPT codes are categorized by the type of services provided. Here are a few essential ABA codes.
Assessment Codes
Code | Definition |
|---|---|
97151 | Behavior identification assessment by a qualified health professional including administering assessments and discussing findings and recommendations. Non-face-to-face data analysis, scoring/interpreting the assessment, and preparing a treatment plan. Use this code for every 15 minutes that the provider spends in face-to-face time with the client and non-face-to-face data analysis. |
97152 | Assessment of behavior conducted by a technician under supervision |
Treatment Codes
Code | Definition |
|---|---|
97153 | Adaptive behavior treatment by a technician under supervision |
97155 | Adaptive behavior treatment with protocol modification by a health professional |
97156 | Family adaptive behavior treatment guidance |
Group Services
Code | Definition |
|---|---|
97154 | Adaptive behavior treatment in a group setting. Includes a group of at least 2 clients but less than 8. |
Crisis Intervention
Code | Definition |
|---|---|
0373T | Adaptive behavior treatment requiring high severity and intensity 0362T is reported based on face-to-face time between a single therapist and client and not the combined time of multiple clinicians. |
Role of occupational therapists in ABA settings
Occupational therapists can collaborate with ABA professionals to integrate sensory strategies and functional tasks into behavior intervention plans. They will focus on sensory-motor function and praxis skills that address and enhance self-care and social participation.
Additionally, occupational therapists will provide environmental modifications, sensory-regulation strategies, strategies to improve executive functioning in the classroom, fine and gross motor development, and classroom sensory strategies, such as sensory diets or adaptive seating, that can improve a child's ability to perform successfully in the classroom and engage with other classmates appropriately.
Furthermore, OTs can implement individualized sensory accommodations tailored to each child's unique needs, ensuring they receive the appropriate level of support.
Evidence-based interventions can help children develop self-regulation skills, improve their ability to transition between activities and enhance their attention span.
OTs also educate teachers and caregivers on implementing these strategies consistently across different environments, fostering the generalization of skills. When OTs collaborate with ABA professionals, it provides the individual with a comprehensive and holistic approach to behavior management, which meets the developmental and functional needs and improves behavioral outcomes for the child.
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Billing considerations
OT services should be billed under appropriate occupational therapy CPT codes unless performed directly under ABA protocols with supervision agreements.
Differentiating between ABA and occupational therapy services is vital to avoid billing conflicts and claim denials. Occupational therapists should delineate roles and contributions clearly when working in multidisciplinary clinics to avoid billing conflicts.
Therapists must provide adequate documentation with specific interventions, justification for therapy services, and a distinction between OT and other services.
Verifying payer policies for collaboration in ABA settings and potential overlap with OT services is essential. It is crucial to confirm whether OTs can provide services under ABA billing codes or if there are any specific requirements for supervision or co-signing documents. This helps prevent insurance disputes and ensures compliance with reimbursement policies.
Ethical and professional guidelines
Occupational therapists should ensure that ABA-related tasks align with their professional scope of practice.
Occupational therapists should also remain within their scope of practice and refrain from providing and implementing ABA interventions outside their training and licensure requirements.
Occupational therapists should also be aware of the state and federal regulations and guidelines for ABA and OTs.
Occupational therapists should focus on holistic, functional goals that integrate behavioral and occupational needs. The overall goal is to improve the individual's quality of life.
Therefore, therapists should follow these ethical and professional guidelines.
- Use evidence-based interventions
- Implement best-practice guidelines
- Obtain informed consent from caregivers and clients
- Collaborate with families and providers to set goals
- Gather informed consent from caregivers and clients
When a client receives a comprehensive, collaborative, and holistic approach to their care, it enhances the treatment of neurodivergent individuals such as those with autistic spectrum disorders and other neurological and developmental conditions.
When ABA and occupational therapists work collaboratively, they can provide interventions that address individuals' behavioral and functional goals.
Understanding ABA CPT codes is vital for occupational therapists to achieve effective collaboration and billing accuracy in interdisciplinary settings. Having the appropriate knowledge of the CPT codes allows for improved communication, accurate billing, and efficient multidisciplinary teamwork, which benefits the clients through a holistic and integrated approach.
By recognizing their unique contributions and aligning their interventions with ABA strategies, OTs can maximize their impact in behavior-focused therapy environments.
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How EHR and practice management software can save you time with insurance billing for therapists
EHRs with integrated billing software and clearing houses, such as TheraPlatform, offer therapists significant advantages in creating an efficient insurance billing process. The key is minimizing the amount of time dedicated to developing, sending, and tracking medical claims through features such as automation and batching.
What are automation and batching?
- Automation refers to setting up software to perform tasks with limited human interaction.
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Which billing and medical claim tasks can be automated and batched through billing software?
- Invoices: Create multiple invoices for multiple clients with a click or two of a button or set up auto-invoice creation, and the software will automatically create invoices for you at the preferred time. You can even have the system automatically send invoices to your clients.
- Credit card processing: Charge multiple clients with a click of a button or set up auto credit card billing, and the billing software will automatically charge the card (easier than swiping!)
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- Automated claim creation and submission: Batch multiple claims with one button click or turn auto claim creation and submission on.
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- Automated payment posting: Streamline posting procedures for paid medical claims with ERA. When insurance offers ERA, all their payments will post automatically on TheraPlatform's EHR.
- Tracking: Track payment and profits, including aging invoices, overdue invoices, transactions, billed services, service providers.
Utilizing billing software integrated with an EHR and practice management software can make storing and sharing billing and insurance easy and save providers time when it comes to insurance billing for therapists.
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More resources
- Therapy resources and worksheets
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- The Ultimate Insurance Billing Guide for Therapists
- The Ultimate Guide to Starting a Private Therapy Practice
- Mental health credentialing
- Insurance billing 101
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References
Coalition, A. C. (2024, December 10). Frequently asked questions - ABA Coding Coalition. ABA Coding Coalition. https://abacodes.org/frequently-asked-questions
CPT® Code 97151 - Adaptive Behavior Assessment Procedures - Codify by AAPC. https://www.aapc.com/codes/cpt-codes/97151
EverNorth Provider - Resources - Billing Codes for Applied Behavior Analysis. https://static.evernorth.com/assets/evernorth/provider/resourceLibrary/behavioralResources/doingBusinessWithUs/cbhDBwCBillingCodesForABA.html
FAQs about ABA CPT codes
Which ABA CPT codes should OTs collaborating in ABA settings know?
Commonly referenced codes include 97151 (behavior identification assessment), 97152 (technician assessment), 97153 (adaptive behavior treatment by technician), 97155 (protocol modification by QHP), 97156 (family guidance), 97154 (group treatment), and Category III crisis/intensive codes 0362T and 0373T. Check payer policies for exactly who may perform/bill each service.
Can occupational therapists bill ABA codes directly?
It depends on payer rules, supervision requirements, and your scope. Some payers require specific provider types (e.g., BCBA) or documented supervision for certain ABA codes. Always verify with the payer and align documentation to the billed service. The ABA Coding Coalition’s materials are a good starting point.
How can OTs avoid denials when collaborating with ABA teams?
Keep roles and services clearly delineated (OT vs. ABA), match documentation to the exact code billed, confirm payer-specific requirements (e.g., modifiers, supervision, authorizations), and use an EHR to automate claims, ERA posting, and validation to catch errors before submission.
