ABA Billing Codes

ABA Billing Codes

Applied behavior analysis is a type of therapy for those diagnosed on the autism spectrum and has developmental disorders in categories like language and social interaction.

 

If you’ve tried looking for information on autism CPT codes and other codes related to applied behavior analysis in the past, you know it can get confusing quickly. Especially with all the current changes in applied behavior analysis billing codes that are happening.

 

Background Information

Our goal is to provide you with the information you need to give you the confidence and knowledge to assist when billing for services.

 

Properly billing for services is extremely important for both the provider and the patient. To receive payment for your services all codes need to be correct. And if you do not receive payment, it can be challenging to stay in practice.

 

Billing correctly affects your patients as well. If you incorrectly submit your codes, their insurance may deny the claim and then unexpected payment fall on your patients.

 

The American Medical Association has put together Applied Behavior Analysis (ABA) services to make submitting electronic claims more efficient and to keep all providers on the same page.

 

CPT Codes

Tests, evaluations, and another diagnosis within the medical field use Current Procedural Terminology (CPT) for billing. They function as a uniform way to charge both outpatient and office procedures.

 

CPT is considered the United States standard for coding of medical procedures. They identify any services provided and CPT codes are how insurance companies decide how much to pay the physician for those services.

 

Interested in having us manage your insurance billing for you? Learn more here.

 

Multiple categories divide CPT codes. The ones applied behavior analysis therapy is concerned with fall under Category III. Category III CPT codes are temporary tracking codes. The intention is to replace CPT Category I unlisted codes, or rather codes that are needed but have not previously existed.

 

CPT Category I codes must be FDA approved and are used by multiple healthcare professionals in many practices. Eventually, Category III codes will become systematic and standard within ABA services and allow for straightforward and efficient billing and processing of applied behavior analysis services.

 

A CPT Editorial Panel meets three times a year to address any issues with emerging technology or other procedural concerns.

 

These codes were implemented on July 1, 2014, and are continually being reviewed and updated. Here we will specifically discuss CPT III tracking codes 0359-0374T

 

CPT codes for applied behavior analysis work as a tiered system, building off each other. This will be explained in greater detail further on.

Definitions

A billing professional is considered any physician or other qualified healthcare professions (QHCP) that specializes in adaptive behavior treatment such as a behavior analyst or licensed psychologist.

 

An assistant or technician is a trained individual who delivers services under the care and direction of a QHCP.

Understanding Codes

Understanding which ABA billing codes are which and when to use them is essential to billing properly. Recording time is crucial when reporting ABA CPT codes, as you will see below.

0359T

This ABA code is used for the initial behavior identification assessment. A qualified healthcare provider does the evaluation; typically, a board certified behavior analyst (BCBA) or a psychologist specializing in behavior analysis.

 

This service is untimed. However, an estimate of 90 minutes was the base used from practitioner input. Depending on the individual, the time can be shorter or longer.

 

The assessment gives information for the qualified healthcare profession to determine if additional evaluations are required or if treatment should be initiated immediately.

 

Also, use the 0359T code in the case of a 6-month re-assessment.

0360T – 0361T

These ABA codes are used together depending on the amount of time the service requires for a specific individual.

 

0360T codes for the procedure used for the first 30 minutes of each day of additional time. If the assessment requires more time than the initial 30 minutes, use code 0361T. 0361T is billed for each additional 30 minutes done on the same day.

 

Multiple 0361T codes may be needed. If an assessment takes 90 minutes, then two 0361T codes are used.

 

A technician can implement the follow-up assessment, but the QHCP uses the data to create a baseline and develop a specific treatment plan and goals for the individual.

 

Example: If you see a patient on Monday for assessment, bill the first 30 minutes of the visit as 0360T and bill any additional time for the same visit as 0361T in 30-minute sections.

 

The next time you see the patient for additional assessment, the first 30 minutes of the visit will again be billed as 0360T and any additional time as 0361T in 30-minute sections.

 

If a patient has two separate sessions in one day, code 0360T is only billed once for the day, all additional time, even different sessions, is billed as the extra time under 0361T. This is true if two separate technicians see the patient because time charged is for the entire team.

 

Some insurers will cap the frequency of using code 0361T, so make sure to monitor all explanations of benefits carefully.

0362T – 0363T

In the case of severe destructive behavior, ABA code 0362T follows 0359T procedure. A technician administers the exposure behavioral follow-up assessment, but the qualified healthcare profession has onsite direction.

 

The 0362T procedure is again, the first 30 minutes of each day for additional assessment.

 

0363T would be used for each additional 30 minutes in a day and may be used several times, depending on the amount of time spent with the patient.

 

A technician under the direction of a qualified healthcare profession can implement these services, but the QHCP interprets the data to identify and plan for effective and efficient interventions.

 

Note: All patients will receive a 0359T followed by 0360T/0361T codes or 0363T/0364T codes depending on the severity of the behavior. Once the follow-ups have occurred, a finalized treatment plan and direct services (as discussed below) will begin.

0364T – 0365T

0364T is the ABA code to use for the first 30 minutes of adaptive behavior treatment. Adaptive behavior treatment is when protocol moves into the actual treatment of the patient, rather than assessment.

 

A technician administers this service and any additional 30 minutes are coded as 0365T.

0366T – 0367T

These next ABA codes apply to group adaptive behavior treatment by protocol. Utilizing group treatment has the first 30 minutes falls under code 0366T.

 

Any additional 30-minute increments fall under code 0367T. Group treatment has a maximum of eight patients.

0368T – 0369T

Modifying the current treatment and required supervision to make such changes is done by a QHCP. This may included protocol demonstrations to technicians, guardians, or caregivers, but the patient is present during this time.

 

Use ABA code 0368T for the first 30 minutes of this service.

 

Bill additional 30 minutes with code 0369T.

0370T

When family members require training and guidance in behavior treatment, use ABA code 0370T. This is time the QHCP spends with the patient’s caregivers without the patient present. The time is untimed but typically around 60-75 minutes. This code can only be reported once per day per patient.

0371T

Use ABA code 0371T for multiple family group treatment guidance. Caregivers for multiple patients work with the qualified healthcare profession without the patient present.

 

A maximum of 8 patient families can meet for this service. It is also untimed but typically around 90-105 minutes. This code can only be reported once per day per patient.

0372T

Bill adaptive behavior treatment social skills group with ABA code 0372T. It is untimed, but typically around 90-105 minutes. A maximum of 8 patients is allowed. The qualified healthcare profession is present for this service.

0373T – 0374T

For extreme destructive behavior, and exposure adaptive behavior treatment with protocol medication uses ABA code 0373T for the first 60 minutes.

 

Any additional 30 minutes falls under 0374T.

 

A technician administers this service with onsite direction from qualified healthcare profession.

T1023

Use this ABA code when a board-certified behavior analyst performs the outcome measure testing.

 

Use the Third Edition of Vineland Adaptive Behavior Scale or the Second Edition of Social Responsiveness Scale for this evaluation.

 

This code requires an authorization – usually issued every six months. This code is untimed.

Calculating Time

CPT states that a unit of time is billable when the midpoint is passed.

 

Any untimed services (such as 0359T and 0370T) are reported as one code no matter the actual duration of the service.

 

Timed services (codes 036T-0369T) are reported based on face-to-face time on the date of the service. Pair timed codes when billing. This means the first 30 minutes (anywhere from 16-45 minutes) or first 60 minutes (31-75 minutes) report with the first code and report additional 30 minutes increments following on the same date with the second code.

 

Example: Patient receives adaptive behavior treatment by protocol with 100 minutes of technician time would be reported as 1 unit of 0364T and two units of 0365T.

 

Keep in mind, when billing for untimed services, office time taken to develop the treatment plan and write the report, as well as any discussion of findings or recommendations with the caregivers is included in the cost as a practice expense. Any codes that require documentation of face-to-face time must have all time recorded as time the patient was present.

Guidance During Billing

When preparing for ABA therapy billing, attention to detail makes all the difference.

 

Any one-on-one services under CPT 0364 should list the behavior technician or assistant behavior analysts as render provider in Box 24. All other services will have the authorized ABA supervisor in Box 24 to make a claim eligible for reimbursement.

 

Listing an authorized applied behavior analysis supervisor or behavior technician as the rendering physician for any services other than 0364T the claim will cause rejection of the claim. A technician’s time is included as part of the QHCP practice expenses.

 

Services are only to be billed by the qualified healthcare profession.

 

Claims also require HIPAA taxonomy designation for each type of provider. The approved designations are:

  • Master’s level and above for behavior analyst – 103K00000X
  • Assistant behavior analyst – 106E00000X
  • Behavior technician – 106S00000X

 

Any remote supervision does require the inclusion of the GT modifier.

Rates for Reimbursement

Rates for reimbursement are based on individual analyses by commercial and Centers for Medicare and Medicaid Services ABA rates. These can vary depending on location.

 

Rates also depend on the terms of your network agreement as a network provider.

Conclusion

We hope you found this information useful. Correct billing is essential to getting claims approved quickly and efficiently.

 

With our system, you will have access to expansive knowledge of the new CPT codes for ABA therapy and the ease of knowing you are billing correctly for your practice and your patients.

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