Wiki Tricare ABA Billing for RBTs

[Cwebb85]

We are receiving conflicting information and Tricare's manual is worded in a confusing manner. If we have an RBT (Registered Behavior Technician) that is Tricare certified, do we bill for their services (97153) under their NPI? Or under the supervising BCBA?

 

[AHVC]

Under the NPI/name of the certified RBT (who performed ABA services 1:1 with beneficiary - 97153) - Box 24J is to indicate the rendering provider.

Refer to TRICARE Operations Manual - TRICARE ABA Manual can be located at https://manuals.health.mil/pages/v3...l=TO15&Change=79&Type=AsOf&Filename=C18S4.PDF

There are 3 levels of ABA reimbursement depending on provider type - (less any network discounts of provider/CSP - who receives the reimbursement)
CPT 97153. Adaptive Behavior Treatment by Protocol. CPT 97153 is a timed codes reimbursed at $31.25 per 15-minute increments ($125.00/ hour) for authorized ABA supervisors, $18.75 per 15-minute increment ($75.00/hour) for assistant behavior analysts, and $12.50 per 15-minute increment ($50.00/hour) for BTs.