In the ever-evolving landscape of ABA therapy billing, staying updated with the latest CPT codes is crucial. One such code that has garnered attention is CPT code 97152. This article aims to demystify this code, offering insights into its application, nuances, and best practices.
What is CPT Code 97152?
CPT code 97152 stands 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, each 15 minutes.” In simpler terms, it’s used for assessments that support the identification of behaviors, conducted by a technician under supervision.
When to Use CPT Code 97152?
This code is specifically designed for behavior technicians (such as RBTs) who are conducting assessments to support the identification of problematic or target behaviors. It’s essential to note that this code is billed in 15-minute increments, meaning if an assessment takes 30 minutes, you’d bill for two units of 97152.
CPT code 97152 is specifically tailored for behavior technicians, such as Registered Behavior Technicians (RBTs), who are conducting assessments to support the identification of problematic or target behaviors. These assessments are foundational in ABA therapy as they help in charting out a tailored intervention plan for the individual.
- Initial Assessments: When a new client begins ABA therapy, an initial assessment is crucial to understand the baseline behaviors and challenges. An RBT, under the guidance of a BCBA, might use structured play, observation, or direct interaction to identify specific behaviors that need intervention. For instance, an RBT might observe a child during free play to note instances of self-injurious behaviors, aggressive outbursts, or repetitive actions. Each 15-minute block of this assessment would be billed under 97152.
- Re-assessments: Over time, as therapy progresses, re-assessments become necessary to gauge the effectiveness of interventions and modify treatment plans. For example, after six months of therapy, an RBT might reassess a child to see if previously identified tantrums have reduced in frequency or intensity. This re-assessment, crucial for updating the therapeutic approach, would also fall under 97152.
- Transition Assessments: When a client is transitioning between different settings, such as moving from a school-based ABA program to a home-based one, assessments are vital to understand how behaviors manifest in different environments. An RBT might spend time observing a teenager with ASD during school recess and then at home during family dinner. These observations, aimed at understanding the behavioral differences in distinct settings, would be billed using 97152.
- Post-intervention Assessments: After a specific intervention or therapy module, it’s essential to assess its impact. For instance, after a 3-month module focusing on improving social interactions, an RBT might assess a child’s behavior during a group play session to see if there’s an increase in positive social initiations. This targeted post-intervention assessment would be coded under 97152.
It’s essential to remember that while 97152 is versatile, it’s specifically for behavior identification supporting assessments conducted by technicians. Each 15-minute block of assessment is billed as one unit of 97152. So, if an RBT spends an hour conducting such an assessment, it would be billed as four units of this code.
Key Considerations for 97152:
- Supervision Requirement: The assessment must be conducted under the direction of a qualified healthcare professional. This doesn’t mean the BCBA needs to be present physically, but they should be guiding the process.
- Face-to-Face: The code emphasizes face-to-face interaction, underscoring the importance of direct engagement with the patient during the assessment.
- Exclusivity: If you’re billing for 97152, you cannot bill for other assessment or treatment codes during that same 15-minute block.
Benefits of Properly Using 97152:
- Accurate Reimbursement: By correctly using this code, ABA practices ensure they’re adequately compensated for the valuable assessment services they provide.
- Clear Documentation: Proper usage allows for clear documentation of the services provided, which can be beneficial in case of audits or reviews.
- Enhanced Patient Care: By ensuring that technicians are spending dedicated time on behavior identification assessments, practices can enhance the quality of care they provide.
- Only for Initial Assessments: One of the prevalent misconceptions is that 97152 is exclusively for initial assessments when a client first starts ABA therapy. While it’s frequently used during the onset of therapy, this code also covers re-assessments, transition assessments, and post-intervention evaluations, as long as they are conducted by behavior technicians.
Example: If an RBT reassesses a client’s behavior after a year of therapy to update the treatment plan, this session can still be billed under 97152, even though it’s not the client’s first assessment.
- BCBAs Can Use This Code: Some believe that Board Certified Behavior Analysts (BCBAs) can bill their assessment sessions under 97152. However, this code is specifically for behavior technicians. BCBAs have separate codes for their assessment services.
Example: If a BCBA conducts a comprehensive behavior assessment, they would not use 97152. Instead, they’d use a different CPT code tailored for their level of expertise and the nature of the assessment.
- Unlimited Usage: Another misconception is that there’s no limit to how many times 97152 can be billed for a client. While there’s flexibility, insurance companies often have guidelines on the frequency of assessments. Overusing this code can lead to billing disputes.
Example: If an RBT conducts assessments every week for several months without a clear clinical rationale, insurance providers might question the necessity and frequency of these sessions.
- Covers All Types of Assessments: Some practitioners mistakenly believe that any assessment conducted by an RBT can be billed under 97152. However, this code is specifically for behavior identification assessments. Other types of evaluations or tests would require different codes.
Example: If an RBT is conducting a specific skill acquisition assessment to determine a child’s current academic abilities, this might not fall under 97152, as it’s not directly related to behavior identification.
- Only for Children: ABA therapy and its associated billing codes, including 97152, are not just for children. While ABA is commonly associated with pediatric care, especially for children with autism, it’s applicable to adults as well. 97152 can be used for assessments of adults when conducted by behavior technicians.
Example: An RBT assessing the behaviors of an adult with traumatic brain injury in a rehabilitation setting would still use 97152 for behavior identification assessments.
Imagine an RBT working with a young child newly diagnosed with ASD. The RBT, under the guidance of a BCBA, conducts a behavior identification supporting assessment to understand the child’s specific challenging behaviors. This assessment, which involves direct interaction with the child, takes 45 minutes. In this scenario, the ABA practice would bill three units of CPT code 97152.
CPT code 97152 is a valuable tool in the arsenal of ABA billing. By understanding its nuances and applications, ABA therapists and practices can ensure they’re not only providing top-notch care but also receiving the compensation they deserve. As with all billing practices, it’s essential to stay updated, seek continuous education, and always prioritize the well-being of the patients you serve.