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.


45th Annual Convention; Chicago, IL; 2019

Event Details

Previous Page


Panel #219A
2019 CPT I Billing Codes for Applied Behavior Analysis: Adoption, Interpretation, and Next Steps
Sunday, May 26, 2019
9:00 AM–10:50 AM
Hyatt Regency East, Concourse Level, Michigan 1 A-C
Domain: Service Delivery
CE Instructor: Wayne W. Fisher, Ph.D.
Chair: Wayne W. Fisher (Munroe-Meyer Institute, University of Nebraska Medical Center)
WAYNE W. FISHER (Munroe-Meyer Institute, University of Nebraska Medical Center)
JULIE KORNACK (Center for Autism and Related Disorders)

Since 2009, ABAI has been working with the American Medical Association to establish billing codes for ABA. In 2014, the AMA adopted Current Procedural Terminology (CPT) Category III (or temporary) codes for adaptive behavior services, and the majority of those codes became Category I (permanent) codes, effective January 1, 2019, as a result of joint efforts by ABAI, APBA, Autism Speaks, and the BACB. The AMA codes recognize that ABA services represent empirically supported and medically necessary interventions. As insurers, health plans, and managed care organizations have implemented the CPT I codes, behavior analysts have grappled with a wide array of issues, including contradictory interpretations of the codes, claims denials, and newly imposed hour limits. In this presentation, we will review the activities that the codes are intended to capture, identify the varying interpretations of the codes by funding sources, and discuss what comes next as we work to preserve and expand access to ABA that reflects best practices.

Instruction Level: Basic
Target Audience:

Behavior analysts

Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) recognize the varying interpretations of the billing codes by funding sources; (2) know the appropriate use of Medically Unlikely Edits (MUEs); (3) state the difference between concurrent and duplicate billing; (4) state the difference between codes that are valued and codes that are carrier priced.



Back to Top
Modifed by Eddie Soh