Recent News

ABA Coding Coalition Urges CMS to Add ABA CPT Codes to the Approved Telehealth List

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 for adaptive behavior/ABA […]

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U.S. Department of Health and Human Services Extends Public Health Emergency

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 date. The ABA Coding […]

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ABA Coding Coalition Achieves Increase in Medicare MUEs in 2021

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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CMS Releases 2021 Medicare Physician Fee Schedule; ABA Codes Remain Carrier-Priced

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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Coalition Prompts Medically Unlikely Edit Policy Change

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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ABA Providers May Use the New 99072 CPT Code

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 performed during a […]

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ABA Coding Coalition Publishes Model Coverage Policy

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 designed to familiarize […]

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CMS Releases 2021 Medicare Physician Fee Schedule; ABA Codes Remain Carrier-Priced

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, 0373T) will remain […]

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ABA Coding Coalition Urges Utilization of Medicaid MUEs for Adaptive-Behavior (ABA) Services

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 […]

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Important New Resources

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 […]

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