September 16, 2020 The ABA Coding Coalition is pleased to make available its new model coverage policy for ABA services. This document has been developed to assist providers, billers, and payers in implementing comprehensive payer policies for the Category I and modified Category III CPT® codes for adaptive behavior services. The model policy is also […]

August 27, 2020 The Centers for Medicare & Medicaid Services (CMS) released the proposed 2021 Medicare Physician Fee Schedule (MPFS) rule on August 17th. 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, […]

July 6, 2020 Medically unlikely edits (MUEs) are guidelines regarding the maximum per-patient, per-day units of service for health-insurance billing codes. These guidelines are issued by the National Correct Coding Initiative (NCCI) for the Centers for Medicare and Medicaid Services (CMS) to ensure appropriate utilization of medical services. CMS publishes two separate MUE data files […]

April 22, 2020 To help providers and payers contend with the effects of the COVID-19 pandemic on applied behavior analysis (ABA) services, the ABA Coding Coalition has added two resources to its website: The Association of Professional Behavior Analysts (APBA) Guidelines for Practicing Applied Behavior Analysis During the COVID-19 Pandemic, and Reporting CPT Codes for Telehealth […]

April 2, 2020 Many providers of applied behavior analysis (ABA) services are facing extreme challenges in delivering those services in person in light of the health and safety risks posed by the COVID-19 outbreak. Like other healthcare providers, our community is scrambling to determine how to use telehealth in order to minimize disruptions to medically […]

March 19, 2020 ABA providers nationwide are facing extreme challenges in delivering ABA services in person in light of the health and safety risks posed by the COVID-19 outbreak. The entire healthcare community is scrambling to determine how to deliver services via telehealth in order to minimize disruptions to medically necessary care as much as […]

February 12, 2020 On receiving reports from Louisiana providers that the state Medicaid agency had implemented a policy requiring 10 minutes of service to be rendered before a unit of service could be billed with the adaptive behavior (ABA) services CPT codes, the ABA Coding Coalition asked Louisiana Medicaid to rescind the policy and replace […]

January 18, 2020 In response to provider outreach, the ABA Coding Coalition contacted Optum/United Behavioral Health in late December to express concern over their proposed 2020 rounding policy regarding the ABA CPT® codes. Optum proposed to require that 10 minutes of services be rendered in order to report using any of those codes. In our […]

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 […]

December 17, 2019 The Centers for Medicare & Medicaid Services (CMS) released the final 2020 Medicare Physician Fee Schedule (MPFS) rule on November 1. 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, […]