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Association for Behavior Analysis International

The Association for Behavior Analysis International® (ABAI) is a nonprofit membership organization with the mission to contribute to the well-being of society by developing, enhancing, and supporting the growth and vitality of the science of behavior analysis through research, education, and practice.

Frequently Asked Questions on Applied Behavior Analysis Therapy Tracking Codes—CPT 0359T–0374T

CPT® is a registered trademark of the American Medical Association, Copyright 2013–2014 American Medical Association, all rights reserved.

 

Who was on the American Medical Association (AMA) CPT workgroup that developed these codes?

 

Payment

What will the rates be for CPT codes 0359T–0374T?

 

Documentation of Time

A number of the new CPT Category III (tracking) codes include times. I have not been in the habit of documenting times. Is this important to document?

 

Under what code does one perform the tasks of graphing and analyzing baseline data, and graphing and analyzing session data? Additionally, what code is used for the task of writing programs and behavior plans?

 

Behavior Identification Assessment (0359T)

How do the assessment codes relate to one another, and which ones should be used when?

 

The AMA description for 0359T says, Behavior identification assessment, by the physician or other qualified health care professional (QHCP), face-to-face with patient and caregiver(s), includes administration of standardized and non-standardized tests, detailed behavioral history, patient observation and caregiver interview, interpretation of test results, discussion of findings and recommendations with the primary guardian(s)/caregiver(s), and preparation of report.” The code is untimed; however, accomplishing the above tasks should take 10+ hours for the QHCP and should also include 1–2 hours that the QHCP will spend with the ABA technician, the time for which will eventually need to be paid by the agency as well. Is it acceptable to claim 12–20 units of 0359T for an identification assessment, and if so, how many per day?

 

It is my understanding that the initial assessment should be billed with code 0359T. Once that is done, is it mandatory to bill codes 0360T, 0361T, 0362T, or 0363T for the follow-up observation? Or can we go ahead and start billing for therapy using codes 0364T, 0365T, etc.?

 

Which code is used for the 6-month re-assessment?

 

Observational Behavioral Follow-up Assessment (0360T, 0361T)

Are the codes for observational behavioral follow-up assessment (0360T/0361T) used only once in the beginning of an authorization, or can they be used again? If the latter, is it for ongoing updating of goals or any time a reassessment is done?

 

Exposure Behavior Follow-up Assessment (0362T, 0363T)

For codes 0362T and 0363T, can both the qualified health care professional and the technician bill for that time?

 

Adaptive Behavior Treatment (0364T, 0365T)

In the past we have been informed that in order to avoid claims coming back as duplicates, all work done by multiple technicians on the same day for a given client should be added and submitted as total units performed under the appropriate BCBA. Now that the first 30 minutes of a session is billed as 0364T and all subsequent 30 minutes of that session as 0365T, does the same direction apply? For example, if one child has two 90-minute sessions in one day with two separate technicians, is that time submitted as a total of two units of 0364T and four units of 0365T, or can 0364T be submitted only once per day, which would result in one unit of 0364T and five units of 0365T for the same example?

 

Will the authorization for codes 0364T/0365T be given as one block, or will it be necessary to request a specific number of 0364T units and 0365T units? The same question applies for codes 0368T/0369T.

 

Adaptive Behavior Treatment With Protocol Modification (0368T, 0369T)

Which code provides for ongoing supervision?

 

Family Adaptive Behavior (0370T, 0371T)

Is there a code billable by both the BCBA and the technician that accounts for presentation of the treatment plan by the BCBA to the parent/caregiver and the technician without the patient present?

 

Will codes 0370T, 0371T, and 0372T be used as timed codes in 30-minute increments? If not, can they be used once per day? What is the minimum time necessary to bill these codes? How should authorizations for these codes be requested as far as units?

 

Exposure Adaptive Behavior (0373T, 0374T)

There does not appear to be an option for the supervisor to observe a DI session. Would this be coded as 0373T/0374T, even if there isn't a serious behavioral concern?

 

Documentation of Face-to-Face Time

When using codes 0359T or 0360T/0361T for the assessment, can a BCBA continue writing his or her findings after the patient has left, or does this need to be done completely face to face?

 

Most of the codes require face-to-face time with the patient, and almost all require lots and lots of documentation time. Is it OK to claim the documentation time using these codes even if the patient is no longer present as long as services started by treating the patient face to face? In other words, can a qualified health care professional (QHCP) bill for time spent writing up the assessment while not on site? If so, what code should be used?

 

Counting ABA Technician Time

When a patient gets direct care twice a day via different ABA technicians, should both claim 0364T for their first 30 minutes of services, or should only one claim 0364T and the next claim 0365T for his or her first 30 minutes?

 

For exposure behavioral assessment codes 0362T and 0363T, can both the qualified health care professional (QHCP) and the technician bill for that time?

 

ABA Supervision of Technicians

There is no code for supervision, but it is required (approximately 1 hour per 10 hours of direct care by the technician), so how will the qualified health care professional (QHCP) be paid for it?

 

Adaptive Behavior Treatment With Protocol Modification, con't. (0368T, 0369T)

What code would be used for BCBA supervision of technicians?

 

Are codes 0368T/0369T to be used for supervision of a technician when a patient is present, and can a BCBA report these codes at the same time a technician is reporting 0364T/0365T? If not, is there another code set that accounts for supervision?

 

Team Meetings

There is no code for team meetings, but they are practically required, so how will qualified health care professionals and technicians be paid for them?

 

How CPT Billing Codes Were Created

Why weren't the views of practicing behavior analysts incorporated?

 

How did ABAI become involved in the AMA's creation of billing codes for ABA services?

 

Who decides what new insurance billing codes will be considered by the AMA?

 

Why were Travis Thompson and Wayne Fisher part of the AMA workgroup to create the new billing codes?

 

Whose opinions were sought in drafting new CPT codes to be proposed?

 

Why didn't the ABA representatives on the AMA workgroup vet each of the proposed codes with behavioral practitioners before proceeding?

 

Miscellaneous

According to the AMA, observational behavioral follow-up assessments (0360T and 0361T) are to be done by an ABA technician; do you know if that is acceptable in New York in accordance with the rules of Article 167?

 

Code 0359T is untimed (i.e., no units). How much time can be spent on this? Horizon is providing a standard 8 hours for this code, and it is unclear how Aetna or United are handling it. Also, the code is described as "face to face," but office time is required to write the assessment report and the treatment plan. Is a BCBA allowed to bill under this code for the report writing and treatment planning, which are required for the initial assessment?

 

Aetna will require billing with modifiers for each code (one modifier for BCBAs, one for BCaBAs, and one for direct instructors), which brings the total number of possible code options to 48. Is there any way to streamline this moving forward?

 

A big concern for insurance companies in states where insurance reimbursement is new (e.g., Arkansas) is that there is no longer a $50,000/year cap. Some groups are demanding that insurance companies reimburse at extreme rates. Is there a recommended value for rates in these instances?

 

These adaptive behavior codes are Category III. What is the difference between Category III and Category I codes?

 

How should intensive treatment provided and supervised by Early Start Denver Model (ESDM) certified professionals be handled under the new codes?

Modifed by Eddie Soh
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