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The ABA Coding Coalition successfully advocated with the National Correct Coding Initiative for several INCREASES to Medicare MUEs, which take effect on January 1, 2021! The increases are for the following codes: CPT/HCPCS MUE (units of service) 97152 16 97154 18 0362T 16 The Coalition continues to advocate for increases to Medicare MUEs for 97151; however, we […]

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The Centers for Medicare & Medicaid Services (CMS) released the FINAL 2021 Medicare Physician Fee Schedule (MPFS) rule on December 1st. It can be found here. Addendum B, which contains all assigned relative value units (RVUs) for services within the MPFS, clearly indicates that the CPT codes for adaptive behavior (ABA) services (97151-97158, 0362T, 0373T) will remain carrier-priced […]

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After receiving reports from providers that many health plans are utilizing the Centers for Medicare & Medicaid (CMS) MEDICARE values for Medically Unlikely Edits (MUEs) to set per-patient per-day limitations on ABA services, the ABA Coding Coalition made a request of payers nationwide to utilize the CMS MEDICAID MUEs, which allows increased units of service […]

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