Coalition Receives Optum Clarification on Rounding Policy for ABA CPT Codes

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 letter to Optum we pointed out that that policy contradicts American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) guidance to use the midway point of a time-based code’s time increment for rounding purposes (see our letter for details about those rules). For the ABA codes the midway point is 8 minutes, based on the 15-minute-per-unit interval specified in the code descriptors. In response to our letter, Optum has rescinded their policy and issued an FAQ stating that they will follow the rounding guidance from the AMA and CMS. Providers should note that although Optum’s FAQ still states their opinion that conducting at least 10 minutes of services per unit is “best practice,” that is not a requirement. In addition, Optum has indicated that it will not deny claims for services where the midway point of a time-based code’s time increment has been surpassed. If you encounter claims processing difficulties with Optum/UBH related to its rounding policy, please contact us.