Wiki CPT Code 97153 - Bundling of Prior Review by Technician with Direct 1 to 1 Care?

sgorski

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We have a question regarding CPT 97153 - adaptive behavior treatment by protocol.

This is the guidance we have been given for applying the CPT code 97153. Our question is if the technicians work prior to and following a session, as described below, is billable as bundling. We have been discussing amungst ourselves and keep going back and forth. Does anyone have better insight? Thank you

97153 Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes TYPICAL PATIENT: A 4-year-old female presents with deficits in language and social skills. She engages in perseverative speech on one or two preferred topics and displays strong emotional outbursts in response to small changes in routines or when preferred items are unavailable.

CLINICAL EXAMPLE: Prior to the first implementation of any treatment protocols, the QHP and technician review the definitions of treatment targets in the areas of language, social skills, responding to changes in routines, and responding to the unavailability of preferred items in the patient’s treatment plan as well as the written protocols for addressing each of those targets.

Prior to each treatment session, the technician gathers all materials required for that session. The technician also reviews the data and session notes from the most recent treatment sessions.
During each session (face-to-face), the technician implements the treatment protocols and data collection procedures with the patient in the family home and selected community settings. Sessions are designed to provide multiple planned opportunities for the patient to practice each target skill.

After the session, the technician records notes summarizing what occurred and any aspects of the behavioral definitions or treatment protocols that may need to be scrutinized by the QHP. The QHP reviews technician recorded graphed data and notes from all treatment sessions weekly to assess the child’s progress and determine if any treatment targets or protocols need to be revised.
 
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