Recent News
CMS Proposes Rules for Calendar Year 2023 Pricing and Telehealth Approval Status of CPT Codes for ABA Services
August 16, 2022 Recently the Centers for Medicare & Medicaid Services (CMS) published the proposed Medicare Physician Fee Schedule (MPFS) and proposed rule changes for 2023. The agency is proposing that the CPT codes for adaptive behavior/ABA services (97151 – 97158, 0362T, 0373T) remain carrier-priced throughout 2023, as they have been since they went into effect […]
Coalition Updates its Model Coverage Policy
January 19, 2022 The ABA Coding Coalition has updated the Model Coverage Policy for Adaptive Behavior Services, which was initially released in September 2020. The updated version includes two additional modifier codes that some payers want providers to use to indicate services that are being provided via telehealth, and some additional ICD-10 and corresponding DSM-V […]
Coalition Advocates for Changes in TRICARE Autism Care Demonstration Billing Code Policies
November 18, 2021 In March the Defense Health Agency (DHA), which manages the TRICARE Autism Care Demonstration (ACD) program, issued revised policies for that program. They included policies on billing with the CPT codes for adaptive behavior/ABA services that are inconsistent with the code descriptors and related documents published by the American Medical Association as […]
CMS Proposes Pricing for CPT Codes, Updates to Telehealth Coverage in 2022 Medicare Physician Fee Schedule
July 29, 2021 The Centers for Medicare & Medicaid Services (CMS) released the proposed 2022 Medicare Physician Fee Schedule (MPFS) and other proposed rule changes on July 13. The document 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 […]
ABA Coding Coalition Urges CMS to Add ABA CPT Codes to the Approved Telehealth List
June 3, 2021 The Centers for Medicare and Medicaid Services (CMS) publishes a list of services and the corresponding billing codes that are payable under the Medicare Physician Fee Schedule when furnished via telehealth. Many payers use that list to determine whether to authorize telehealth delivery of services. Although CMS approved the 8 Category I CPT codes […]
U.S. Department of Health and Human Services Extends Public Health Emergency
January 26, 2021 Effective January 21, the outgoing Secretary of the U.S. Department of Health and Human Services (HHS) extended the national public health emergency (PHE) through April 21, 2021. That means that all telehealth and other waivers and flexibilities that have been implemented during the PHE will remain in effect until at least that […]
ABA Coding Coalition Achieves Increase in Medicare MUEs in 2021
December 29, 2020 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 […]
CMS Releases 2021 Medicare Physician Fee Schedule; ABA Codes Remain Carrier-Priced
December 29, 2020 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) […]
Coalition Prompts Medically Unlikely Edit Policy Change
December 1, 2020 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 […]
ABA Providers May Use the New 99072 CPT Code
September 24, 2020 Some ABA providers may be aware of the following new CPT code that was issued recently by the American Medical Association (AMA) CPT Editorial Panel, effective immediately (i.e., this month): 99072: Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when […]