In the world of Applied Behavior Analysis (ABA) therapy billing, understanding the nuances of Current Procedural Terminology (CPT) codes is crucial. One such code that frequently comes into play is 97153. This article aims to provide a comprehensive understanding of this code, its applications, and its significance in ABA therapy.
What is CPT Code 97153?
CPT Code 97153 is designated for “Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified healthcare professional, face-to-face with one patient, each 15 minutes.” In layman’s terms, it’s the billing code for direct one-on-one ABA services rendered by a Registered Behavior Technician (RBT) or another behavior technician to a patient. This code emphasizes the structured and protocol-driven nature of ABA interventions.
When to Use CPT Code 97153?
Direct One-on-One Sessions: This code is reserved for face-to-face sessions where the behavior technician directly applies behavior-analytic interventions with the client.
Example: An RBT working with a child on a specific behavior protocol, like a token economy system to reinforce classroom behavior, would bill this time under 97153.
Skill Acquisition: Sessions that prioritize teaching new skills, encompassing areas like communication, social interaction, or daily living skills, utilize this code.
Example: A technician teaching a non-verbal child to use a picture exchange communication system (PECS) for making requests would bill with 97153.
Behavior Reduction: If the session’s primary objective is to mitigate challenging behaviors, such as repetitive behaviors or non-compliance, it’s billed under this code.
Example: An RBT using differential reinforcement to decrease instances of a child’s disruptive vocalizations during family meals would use 97153 for billing.
Common Misconceptions about CPT Code 97153:
Only for RBTs: A prevailing misconception is that only RBTs can bill under this code. In reality, while RBTs are frequent providers, other behavior technicians, under the guidance of a BCBA or equivalent professional, can also utilize this code.
Used for Group Sessions: 97153 is strictly for individualized, one-on-one sessions. Group interventions have their distinct set of codes, ensuring that the nature and dynamics of group therapy are recognized separately.
Includes Supervision Time: This code exclusively represents the time the technician spends in direct interaction with the client. Any supervisory or oversight activities by a BCBA or BCaBA are billed under different codes.
Why is CPT Code 97153 Important?
Reflects Direct Intervention: This code encapsulates the essence of ABA therapy – direct, personalized interventions tailored to individual needs. It underscores the hands-on approach that defines ABA.
Billing Accuracy: Precise coding is the linchpin of accurate reimbursement. By using 97153 appropriately, ABA practices can ensure they’re remunerated correctly, fostering financial stability.
Clear Communication with Payers: In the realm of billing, clarity and precision are non-negotiable. Employing 97153 correctly streamlines communication with insurance entities, minimizing claim rejections and fostering a smoother billing process.
CPT Code 97153 is a cornerstone in ABA therapy billing, representing the direct, one-on-one interventions that many clients receive. By understanding and using this code correctly, ABA practices can ensure they’re accurately compensated for their essential services, ultimately benefiting both the practice and the clients they serve.