How does Cpt Code 97153 Differ from 97155 in Billing?
In ABA therapy, CPT codes 97153 and 97155 differ primarily in the type of service provided and the professional responsible for delivering that service:
- 97153 (Direct Treatment): This code is used for one-on-one therapy sessions where a Registered Behavior Technician (RBT) implements the treatment protocol designed by a BCBA. It focuses on the direct delivery of skill-building or behavior-reduction goals.
- 97155 (Protocol Modification): This code is used when a Board Certified Behavior Analyst (BCBA) is present during a session to oversee and modify the treatment plan. It accounts for clinical supervision and real-time adjustments to the protocol based on the child’s progress, rather than just direct implementation.
Key billing similarities and requirements include:
- Unit Increments: Both services are billed in 15-minute units. Providers must follow the “8-minute rule,” where at least 8 minutes of a block must be completed to bill for one unit.
- Medical Necessity: Both codes require documentation showing that the services are medically necessary for the child’s treatment.
- Separation of Services: Minutes from these different codes cannot be combined; they must be tracked and calculated separately. Billing both on the same day without clearly documenting separate, distinct services can lead to claim denials.
Related FAQs
-
Why is Early Intervention Important in Aba Therapy?
Read More »: Why is Early Intervention Important in Aba Therapy?Early intervention in Applied Behavior Analysis (ABA) therapy is critical because it takes advantage of heightened brain plasticity during a child’s most adaptable years. Clinical research indicates that starting ABA before the age of three offers the best opportunity for…
-
What should I Ask an Out-of-network Aba Therapist before Starting Services in Utah?
Read More »: What should I Ask an Out-of-network Aba Therapist before Starting Services in Utah?When evaluating an out-of-network ABA therapist in Utah, it is important to ask specific questions to clarify expectations and build a trusting partnership. Based on best practices for out-of-network care, you should ask the following: Treatment Philosophy and Goals: Ask…
-
Can I Get Financial Assistance for Out-of-network Aba Therapy for my Child in Utah?
Read More »: Can I Get Financial Assistance for Out-of-network Aba Therapy for my Child in Utah?Yes, financial assistance and reimbursement for out-of-network ABA therapy are available in Utah, primarily through the state’s autism insurance mandate (SB195). This mandate requires private insurers to cover ABA therapy for individuals up to age 21, providing at least $50,000…
-
Is Out-of-network Aba Therapy Covered under Utah’s Autism Insurance Laws?
Read More »: Is Out-of-network Aba Therapy Covered under Utah’s Autism Insurance Laws?Yes, out-of-network ABA therapy is covered under Utah’s autism insurance laws. According to the state mandate (SB195), private insurers are required to provide coverage for Applied Behavior Analysis (ABA) for individuals up to age 21. This law applies to both…
-
What are the Typical Costs for Out-of-network Aba Therapy Providers in Utah?
Read More »: What are the Typical Costs for Out-of-network Aba Therapy Providers in Utah?The typical costs for out-of-network ABA therapy providers in Utah generally range from $100 to $200 per hour for individual sessions. Other sections of the provided information also suggest a broader range of $50 to $150 per hour, depending on…
