ABA Coding Coalition Writes Anthem re: Proposed Changes to Reimbursement Policies

December 17, 2019

The Coalition heard from providers in several states that Anthem was reducing reimbursement rates for CPT codes 97153 and 97155. Antitrust laws prohibit professional organizations like Coalition member the Association of Behavior Analysts (APBA) from negotiating reimbursement rates on behalf of their constituents, but nonprofit professional organizations generally are allowed to advocate regarding payer policies. Therefore, the APBA attorney was enlisted to help the Coalition craft a letter to Anthem leadership in IN, OH, and TX to request reconsideration of that payer’s policies on its implementation of codes 97153 and 97155. We specifically asked Anthem to continue allowing those codes to be billed concurrently and to compensate providers adequately for the work and time involved in delivering the services. We will update providers on any developments of which we become aware in those three states and others where Anthem does business.