Billing Codes
The CPT® codes below have been approved by the American Medical Association (AMA) for applied behavior analysis assessment and treatment – described as “adaptive behavior services” in the CPT® code book. Adaptive behavior services address deficient adaptive behaviors (e.g., instruction following, verbal and nonverbal communication, imitation, play and leisure, social interactions, self-care, daily living, personal safety skills) or maladaptive behaviors (e.g., repetitive and stereotypic behaviors; behaviors that risk physical harm to the patient, others, and/or property). Guidance on the use of these codes is available in the November 2018 CPT® Assistant newsletter published by the AMA. The codes and their descriptors are below.
Adaptive Behavior Assessment
Category I
97151. Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician’s or other qualified health care professional’s time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan
97152. Behavior identification supporting assessment, administered by one technician under the direction of a physician or other qualified health care professional, face-to-face with the patient, each 15 minutes
Category III
0362T. Behavior identification supporting assessment, each 15 minutes of technicians’ time face-to face with a patient, requiring the following components:
· administered by the physician or other qualified health care professional who is on site,
· with the assistance of two or more technicians,
· for a patient who exhibits destructive behavior,
· completed in an environment that is customized to the patient’s behavior.
Adaptive Behavior Treatment
Category I
97153. Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes
97154. Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with two or more patients, each 15 minutes
97155. Adaptive behavior treatment with protocol modification administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes
97156. Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes
97157. Multiple-family group adaptive behavior treatment guidance, administered by a physician or other qualified healthcare professional (without the patient present), face-to-face with multiple sets of guardians/caregivers, every 15 minutes
97158. Group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional face-to-face with multiple patients, each 15 minutes
Category III
0373T. Adaptive behavior treatment with protocol modification, each 15 minutes of technicians’ time face-to-face with a patient, requiring the following components:
· administered by the physician or other qualified health care professional who is on site,
· with the assistance of two or more technicians,
· for a patient who exhibits destructive behavior,
· completed in an environment that is customized to the patient’s behavior.