ABA Billing

[aupchurch]

Does anyone have any ABA billing experience?

 

[TThivierge]

Hi
I know a bit but not done any , just read about it. Here is what I know.....
1. Need a treatment plan pre approved from payer listing type of future counseling treatment for child or family sessions Etc.
2. Treatment plan I think is good for 90 days of sessions, documentation must occur from ABA counselor/therapist after each session. Billed monthly, believe must use modifiers on ABA therapists credentials. Treatment can be provided in office, child s home,. video with Zoom or during school time. This might have changed since COVID pandemic and regs may differ from state to state.
3. There are CPT and DX codes for such treatments. interactive counseling with youth pt. and parent.

Well that is all I know...hope this helps you a bit. Goggle some data and check the NCCI Medicare webs site too on DX and CPT codes for ABA therapist to support treatment for autistic children and young adults..

I hope this helps
Lady T

 

[newbergt]

I bill for Behavioral health ( ABA ) therapy what is your question.

 

[lennysara]

what are the CPT codes?

 

[newbergt]

we use 97151 for the initial assessment .. 97153 for aba therapy, 97155 for supervision of the techs , 97154 for group and 97156 for parent training. With Modifiers ,, HM ,HN, HO ( depends on there level of college degree)

 

[jbhuju]

what about H0004/H0031?

 

[newbergt]

we don't use those.. I would check with your payor ,we are in network with BCBS, BCN, Cigna, Aetna, Optum (UHC) , and Priority health and they don't have us use those codes

 

[Jdiane2011]

Thhose codes were used temporily most payors have updated codes to 97151,97153 ect......

 

[newbergt]

if you have a facebook account there is a group that helps with ABA billing ABA Therapy Billing and Insurance Help.. there is a lot of people on there that will help with any questions you may have

 

[SpaceTG]

Does anyone know how to bill 97153 when you have multiple tech's treating one child at different times. For example the sees them in the morning and the other in the afternoon. This billed under the supervisor but even with an XE modifier on the second 97153 is denied as duplicate.

 

[36nicolegray@gmail.com]

Can anyone clarify the use of 97153? On claim 15000 the rendering should be the supervising and not the tech? With the Modifier of who preformed the tech service for example HN? Or the HO to match the supervisors level? And these a commercial payors.

 

[Cwebb85]

Can anyone clarify the use of 97153? On claim 15000 the rendering should be the supervising and not the tech? With the Modifier of who preformed the tech service for example HN? Or the HO to match the supervisors level? And these a commercial payors.

It's payor specific. Some payors want you to bill 97153 under the supervising BCBA with no modifier. Others want you to use the HO, HN, HM modifiers. Few payors (Tricare, Humana commercial, some Medicaid programs) want you to get an NPI for your techs and bill 97153 under the tech NPI.

 

[Cwebb85]

Does anyone know how to bill 97153 when you have multiple tech's treating one child at different times. For example the sees them in the morning and the other in the afternoon. This billed under the supervisor but even with an XE modifier on the second 97153 is denied as duplicate.

You bill all units of 97153 combined. So if there is 2 hours of 97153 in the morning and 2 hours in the afternoon, you will bill one line item for 16 units total (4 15 minute units per hour).