Recent News
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)971521697154180362T16 The Coalition continues to advocate for increases to Medicare MUEs for 97151; however, we encourage providers to […]
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), […]
ABA Coding Coalition Publishes Model Coverage Policy
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 […]
CMS Releases 2021 Medicare Physician Fee Schedule; ABA Codes Remain Carrier-Priced
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, […]
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 […]
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 […]
UPDATE: Coalition Advocates for Telehealth Delivery of ABA Services During the COVID-19 Pandemic
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 […]
ALERT: Navigating the COVID-19 Impact on ABA Services
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 […]