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.
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