New Category 1 CPT Codes for Applied Behavior Analysis (ABA) Services

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By: Rethink

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Anthony Porcelli, Manager of Billing Services for Rethink Behavioral Health, had the pleasure of attending Dr. Wayne Fisher’s workshop on the new Category 1 CPT Codes for ABA Services, which will be effective January 1, 2019.

I split the workshop into 3 sections:

  1. Interpreting the new Category 1 CPT Codes
  2. Suggestions to help valuate the codes when negotiating rates with payers
  3. The work was undertaken to get the new Category 1 CPT Codes accepted by the American Medical Association (AMA)

The two great advantages I see with the new codes are that they are broken up into 15-minute units to allow for more efficient billing and the ongoing codes are no longer needed.

A quick crosswalk for the more commonly used CPT codes is listed below.

Old Category 3 Code New Category 1 Code
0359T 97151
0360T – 0361T 97152
0364T – 0365T 97153
0368T – 0369T 97155
0370T 97156
0371T 97157

A key talking point of the workshop involved valuating the codes when negotiating rates with payers.

When negotiating rates it is important to demonstrate to payers the amount of work that goes into each service.

For instance, when negotiating rates for a technician appointment (0364T – 0365T) providers should mention the training that is involved between the BCBA and the tech before the appointment, the work that goes on during the actual appointment, and the interpretation of data and session notes created afterward.

To do this, Dr. Fisher suggested that providers consider each CPT Code in 3 parts:

  • Pre-Service
  • Intra-Service
  • Post-Service

Pre-Service includes everything that goes on before the appointment takes place such as training staff and writing protocols.

Intra-Service consists of the work that goes on during the actual appointment itself while Post-Service is the work that happens after a session is completed such as writing progress notes and reviewing data.

By doing this, the provider can adequately describe the full scope of work that goes into each appointment.

A further example is provided below for what goes into a Support/Technician Appointment:

0364T – 0365T

Pre-Service Work

  1. BCBA: Trains a technician to perform the service.
  2. RBT: Attends trainings with BCBA. Reviews patient medical records. Creates materials for sessions.

Intra-Service Work

  1. RBT: Works with client based on protocols created by BCBA.

Post-Service

  1. RBT: Writes session notes. Communicates with BCBA as needed about sessions.
  2. BCBA: Reviews/Approves session notes. Interprets data. Updates treatment plan.

Next Steps

The last piece of the workshop involved discussion on the next steps that Dr. Fisher and his group would be working on involving the new Category 1 CPT Codes.

The first order of business for the group is releasing a “Tool Kit” for providers to help valuate their services when getting ready to negotiate with payers.

Dr. Fisher and his team will also work with the AMA to address the issue of billing for both the RBT and BCBA during overlapping service times.

He believes providers should be able to bill for both services concurrently because the responsibilities of each professional during the mutual session are different.

In Summary

In summation, I believe the new codes will positively affect the ABA world and simplify the aba billing process.

Since the ongoing codes have been eliminated, there will be less line errors during billing, leading to faster payments and less back-and-forth interaction with the insurance companies so that providers can spend more time with their clients.

Also, since the new codes have been assigned category 1 status, I hope that payers will be more uniform with their interpretations of their use which will also make for improved efficiency in billing.

From scheduling the appointment to providing resources for treatment and tracking progress to getting paid – Rethink Behavioral Health will completely support you.

No more juggling systems.

Full Features

Our complete platform features:

  • Billing & Full Revenue Cycle Management (RCM) features electronic claims submission & remittances, eligibility verification, patient statements and payments portal, financial reporting, and more!
  • Staff Training & Resources on-demand, self-paced RBT Training and access to thousands of printable resources.
  • Clinical Programming & Data Collection spend less time on administrative tasks with robust tools for assessment, treatment planning, data collection and progress reporting.
  • Advanced Scheduling Tool Easy appointment set up, view multiple staff & client schedules at once, seamless controls prevent coding and scheduling errors, capture session notes and parent signatures.

Schedule a demo today at your convenience!

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