Recent News
Coalition Receives Optum Clarification on Rounding Policy for ABA CPT Codes
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 […]
ABA Coding Coalition Writes Anthem re: Proposed Changes to Reimbursement Policies
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 […]
CMS Releases 2020 Medicare Physician Fee Schedule; ABA Codes Remain Carrier-Priced
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 […]
Modified Health Behavior Assessment and Intervention Services CPT Codes for 2020
November 25, 2019 The ABA Coding Coalition has learned recently that a number of CPT codes for health behavior assessment and intervention services (96158 – 96171) have been modified for 2020. Those codes are for services to identify and address psychological, behavioral, emotional, cognitive, and interpersonal factors important to the assessment, treatment, or management of […]
CMS Releases 2020 Proposed Medicare Physician Fee Schedule Rule; Suggests No Change for ABA Codes
August 26, 2019 On July 29, 2019 the Centers for Medicare & Medicaid Services (CMS) released their annual notice of proposed rulemaking (NPRM) for the Medicare Physician Fee Schedule (MPFS). As providers may know, these annual proposed and final rule notices are where CMS publishes modified policies and reimbursement rates for all medical services within […]
Welcome to the ABA Coding Coalition Website!
July 19, 2019 The ABA Coding Coalition comprises representatives of APBA, CASP, Autism Speaks, the BACB, and its healthcare and billing consultant. We will be developing and sharing resources to support the implementation of CPT codes for ABA services and advocating for their proper usage. All of our resources and important updates will be published […]
Supplemental Guidance Resource
January 14, 2019 The Steering Committee for the ABA Services Workgroup has prepared the article, Supplemental Guidance on Interpreting and Applying the 2019 CPT Codes for Adaptive Behavior Services, to assist providers, billers, and payers in using the Category I and modified Category III CPT® codes for adaptive behavior services that went into effect January […]
CPT Assistant article
November 30, 2018 An important article about the 2019 CPT codes for adaptive behavior services was published in the November issue of the CPT Assistant, a monthly newsletter of the American Medical Association (AMA). It is imperative for providers, billers, and payers to obtain and use that article in implementing the 2019 codes. Through an agreement with the AMA, […]
MUEs & Payer Implementation
December 19, 2018 If you bill health insurance, please read this message carefully. It contains very important information about implementation of the 2019 CPT® codes for adaptive behavior services. Medically Unlikely Edits. As we have noted in several webinars, presentations, and Q&A sessions, the Medically Unlikely Edits (MUEs) for adaptive behavior services will change January […]
CMS Medicare Physician Fee Schedule final rule published
November 6, 2018 On November 1, 2018 the Centers for Medicare & Medicaid Services (CMS) released the 2019 Medicare Physician Fee Schedule (MPFS) final rule. It includes the following statement regarding the new Category I and revised Category III CPT codes for adaptive behavior services: We note that we intended to assign a contractor price […]