The ABA Coding Coalition comprises representatives of three of the organizations (Association of Professional Behavior Analysts, Autism Speaks, Behavior Analyst Certification Board) and a consultant who participated on the work group that developed the application to the American Medical Association CPT® Editorial Panel that resulted in the code set for adaptive behavior (applied behavior analysis) services that went into effect January 1, 2019. That code set includes eight Category I and two Category III CPT® codes modified from the Category III (temporary) codes for adaptive behavior services that were issued in 2014 pursuant to a process initiated by the Association for Behavior Analysis International (ABAI). The work group, which included representatives of ABAI and operated from 2015 through the end of March 2019, also developed resources to assist providers and payers with implementing the 2019 code set. The principal representative (Lorri Unumb) for the fourth organization in this Coalition (Council of Autism Service Providers) represented Autism Speaks on the previous work group.
The principal aims of the ABA Coding Coalition are to
- support implementation of the 2019 CPT® code set by ABA service providers and payers by responding to inquiries, developing and disseminating information and resources, and communicating with our constituents and other interested parties
- monitor Medically Unlikely Edits (MUEs) for the code set and submit requests for revisions based on provider feedback and payer implementation
- educate ABA service providers about CPT®, MUE, and related processes
- develop and maintain this website as a repository for coding and reimbursement resources and a portal for inquiries
The ABA Coding Coalition’s operating policies and procedures are described here.
The organizations, their principal and alternate representatives, and their consultant are described below.
APBA is a nonprofit professional organization whose mission is to promote and advance the science-based practice of ABA by advocating for public policies and informing, supporting, and protecting practitioners and consumers. Memberships are available for professionals in behavior analysis and other fields, Registered Behavior Technicians, students, and consumers of ABA services.
Gina Green, PhD, BCBA-D is the Chief Executive Officer of APBA. She has developed and evaluated ABA interventions for people with autism and other developmental disorders, trained and supervised ABA practitioners and students, consulted to several ABA service programs, worked on many licensure and funding laws, and held leadership positions in several professional and parent-professional organizations. Dr. Green served as APBA’s principal representative on the work group described above.
Bryan Davey, PhD, BCBA-D, LBA is Chief Executive Officer of Touchstone Health Services, a Joint Commission-accredited nonprofit organization that provides integrated behavioral and physical health services to over 7000 clients and their families at five locations across Arizona. He has worked as a special education teacher, owner and administrator of ABA service agencies, and consultant to schools, businesses, health plans, state agencies, and ABA programs around the U.S. Dr. Davey has served on the Boards of the California and Arizona Associations for Behavior Analysis as well as APBA. He was APBA’s alternate representative on the work group described above.
CASP is a nonprofit association of nearly 100 for-profit and not-for-profit agencies that collectively deliver more than $1 billion in services to 50,000+ children and adults with autism each year. CASP exists to promote high-quality and cost-effective care, and achieves its mission by training organizational leaders, developing standards, advocating for evidence-based practice, and fostering collaboration among stakeholders.
Lorri Shealy Unumb, JD became the Chief Executive Officer of CASP in June 2019 after having served for more than a decade as the Autism Speaks Vice President for State Government Affairs. In her role with Autism Speaks, she spearheaded the autism insurance reform movement that has resulted in 49 states adopting laws that require certain health plans to cover ABA and other services for people with autism. Prior to that she was an appellate litigator with the U.S. Department of Justice and a professor at the George Washington University Law School and the Charleston School of Law. She and her husband Dan founded the nonprofit Autism Academy of South Carolina and wrote the academic textbook Autism and the Law. Ms. Unumb was the principal representative for Autism Speaks on the work group described previously.
Tim Courtney, MS, BCBA is the Chief Operations Officer for LittleStar ABA Therapy, a nonprofit organization providing ABA services at five locations around Indiana. He has worked as direct care staff, a BCBA, and Clinical Director in ABA programs serving diverse populations, focusing primarily on individuals with autism during the past 10 years. Within LittleStar Tim has worked to create effective treatment planning and other processes for working with health insurance companies. He has given many workshops and other presentations on treatment planning, medical necessity review, and addressing adverse determinations by health plans.
Autism Speaks is a non-profit organization dedicated to promoting solutions, across the spectrum and throughout the life span, for the needs of individuals with autism and their families through advocacy and support; increasing understanding and acceptance of people with autism spectrum disorder; and advancing research into causes and better interventions for autism spectrum disorder and related conditions.
Mike Wasmer, DVM is Director of State Government Affairs for Autism Speaks. Since leaving the practice of veterinary medicine to join Autism Speaks in 2011, Dr. Wasmer has helped lead the successful autism insurance reform movement. Prior to that he founded and led the Kansas Coalition for Autism Legislation, which was instrumental in the creation of the Kansas Autism Task Force and passage of a law requiring the Kansas state employees’ health plan to cover ABA services for people with autism. Dr. Wasmer served as the alternate representative for Autism Speaks on the aforementioned work group.
Judith Ursitti, CPA is Director of State Government Affairs for Autism Speaks, where she has participated in the passage, implementation, and enforcement of autism insurance laws in multiple states. Before joining Autism Speaks she volunteered as advocacy chair for the organization’s New England and North Texas chapters, chaired the inaugural Dallas Fort Worth Walk for Autism Speaks, and served as a member of the Parent Advisory Council for the Autism Speaks 100-Day Kit.
The BACB is a nonprofit corporation established in 1998 to meet professional credentialing needs identified by behavior analysts, governments, and consumers of behavior analysis services. Its mission is to protect consumers of behavior analysis services by systematically establishing, promoting, and disseminating professional standards.
Wayne W. Fisher, PhD, BCBA-D, LP is the H.B. Munroe professor of behavioral research and director of the Center for Autism Spectrum Disorders in the Munroe-Meyer Institute and Department of Pediatrics at the University of Nebraska Medical Center. Previously he served as executive director of Neurobehavioral Programs at the Kennedy Krieger Institute and the Marcus Behavior Center at the Marcus Institute, where he built highly regarded clinical-research programs in autism and developmental disabilities. He has published extensively on ABA interventions for people with autism and severe behavior disorders. Dr. Fisher has been involved in efforts to obtain CPT® codes for ABA services from the outset, first as a co-author of the ABAI application to the AMA CPT® Editorial Panel that ultimately resulted in the 2014 Category III codes for adaptive behavior services, then as ABAI’s alternate representative on the work group described above.
James E. Carr, PhD, BCBA-D is the Chief Executive Officer of the BACB. In addition to his work on credentialing ABA practitioners, Dr. Carr has developed and evaluated ABA interventions for people with developmental disorders and for training practitioners, led state and regional behavior analysis associations, and trained ABA practitioners-to-be at the University of Nevada-Reno, Western Michigan University, and Auburn University. He served as the BACB’s principal representative on the aforementioned work group.
Jenna Minton, JD is the President of Minton Healthcare Strategies, which specializes in guiding client organizations in the development and subsequent valuation of CPT® codes and related American Medical Association and Centers for Medicare & Medicaid Services regulatory processes. She also serves as the Director of Operations for Residential Options, Inc., which serves about 300 clients with autism and other developmental disabilities at three learning centers in Michigan. From 2016 through the end of March 2019, Ms. Minton guided and contributed substantially to the efforts of the work group described above.