After August 1st, 2021 all authorizations requested on or CPT code 97151, for assessment and treatment plan development, need to be authorized for up to 32 units. This translates into a total of 8 hours for an initial assessment, which is broken down into 24 units, comprising up to 6 hours for all subsequent authorization periods.
Though it’s also worth noting that CPT code 97151 still needs to be conducted over 14 calendar days or less. This means that as an ABA therapist, or mental healthcare provider, you will now have only 8 hours to complete the initial assessment for a patient with another six hours left in reserve for things like reassessments and diagnostics associated with reassessment.
Scheduling is also critical since all 32 of those hours need to be used within 14 days. This includes the PDDBI assessment. All outcomes also need to be measured via Vineland, SRSS, PSI, SIPA, or a similar code.
What Is Considered In An Assessment?
When it comes to using CPT Code 97151 for ABA therapy purposes of an initial assessment, the process includes initial behavior identification assessment. This is a period of time that covers the units spent working face-to-face with the patient, as well as time spent consulting with the patient’s guardians or caregivers while investigating findings or seeking recommendations for developing a treatment plan.
These units of time also include all time spent working outside of interactions with the patient to do things like:
- Analyze past data
- Score the assessment
- Applying analytics to interpret the assessment
- Preparing the treatment plan
Using CPT Code 9712 For Behavior Identification Supporting Assessments
This is a situation where the CPT Code 97152 is used by a single technician under the direction of a qualified healthcare professional. It requires a direct face-to-face session with a specific patient. This is typically used with patients who exhibit destructive behavior and often need to be observed under the care of two or more technicians in a specialized environment where security measures need to be kept in place to protect the practitioner. Though in a case such as this, the modifier code 0362T is used.
Can CPT Code 97151 Be Used For Virtual Visits?
When it comes to ABA therapy purposes CPT Code 97151 can only be used for in-person face-to-face visits, when it comes to billable units. This includes face-to-face interactions with the patient, as well as their parents, or the patient’s caregivers.
Can CPT Code 97151 & CPT Code 97152 Be Billed Concurrently?
Technically both CPT Codes 97151 and 97152 can be billed concurrently. Though this is only as long as the criteria in the descriptors of both codes are met. By definition CPT code 97152 is for Behavior identification supporting assessment, administered by one technician under the direction of a physician or other qualified healthcare professional, face-to-face with the patient, that lasts up to 15 minutes.
Can CPT Code 97151 Be Used For Assessments In A Group Visit?
When it comes to ABA therapy medical billing CPT Code 97151 can only be used for in-person face-to-face assessment with a patient, their parents, or another type of caregiver. When it comes to assessments in a group setting, an ABA therapist would the protocol is identified by CPT Code 97154. In the case of group treatments, the protocol modification is to use CPT Code 9715.
What Happens If I Use CPT Code 97151 Incorrectly?
The data-driven nature of ABA therapy can leave a lot of ABA therapists understandably scratching their heads when it comes to applying the correct codes for all situations. CPT Code 97151 is one of the more challenging. Unfortunately, like a lot of medical billing code errors can lead to claim delays, denials, and possible claim rejections. This can have the net effect of causing inconsistent delays in your practice’s revenue stream.
The Benefits Of Outsourcing Your Medical Billing & Coding
A lot of ABA therapists will turn to a third-party agency like Operant Billing Solutions to handle their medical coding and medical billing services. Several benefits go beyond ensuring that CPT Code 97151 is used correctly. This includes things like:
A Consistent Revenue Stream
A lot of medical coding errors lead to claim rejections and claim denials. Even if the information is corrected to have the claim approved by the payer institution, the delay can cause significant inconsistencies in your practice’s revenue stream.
More Time For Patients
By outsourcing your ABA therapy practice’s medical billing needs, you will inevitably have more time to focus on your current patients as well as having more units of clinical time to serve new patients. This includes assessments where CPT Code 97151 is applicable.
Greater Accuracy In Medical Billing
A lot of small practices and solo ABA therapy practitioners have to wear multiple hats to keep their practice thriving. Unfortunately, most don’t have a great deal of experience or expertise in the realm of medical billing and coding. This leads to a plethora of understandable errors that are unfortunately still considered unacceptable by insurance providers and public health institutions.
When you outsource your medical coding and billing practices to an experienced third-party agency like Operant Billing Solutions, you can trust that highly trained technicians are keeping a sharp eye out for the correct use of all CPT codes. Our medical billing specialists know when and how CPT Code 97151 should be used in ABA therapy, and when another code might be more applicable. This will greatly reduce delays, claim rejections, and the possibility of claim denials.
Time To Expand The Scope Of Your Practice
A lot of ABA therapists who outsource their medical coding and billing to a third party agency find that not only do they enjoy a more consistent revenue stream, but that they also have more time to do things like continue their education, earn additional accreditation, or expand the scope of their practice, without compromising their available clinical hours.