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WEBAetna Rescinds Policy Ending Telehealth Coverage for ABA Services in December 2023. December 11, 2023 Earlier this year, Aetna issued a statement indicating that they would be ending telehealth coverage of CPT codes 97151, 97153, 97155, 97156, and 97157 as of December 1, 2023. The Coalition wrote to the company in November to ask that they
Actived: 1 days ago
Frequently Asked Questions ABA Coding Coalition
WEBCPT codes 0362T and 0373T require a QHP to be “on site” whenever those services for destructive behavior are delivered, which means that the QHP must be nearby and immediately available and interruptible to provide assistance and direction to the behavior technicians who are rendering 0362T or 0373T (CPT Assistant, November 2018).
ABA Providers May Use the New 99072 CPT Code
WEBThe Coalition recommends that ABA providers read and digest the information about CPT code 99072 in the Sept. 8, 2020 CPT Assistant, and if they can meet the requirements for reporting it, ask payers to add that code to their contracts, citing the information in this message. Note that the code descriptor will have to be manually …
Applied Behavior Analysis Treatment of Autism Spectrum …
WEB3 ® SECTION 1: EXECUTIVE SUMMARY. The purpose of this document is to inform decision-making regarding the use of Applied Behavior Analysis (ABA) to treat medically necessary conditions so as to develop, maintain, or restore, to the
ABA Coding Coalition Urges Utilization of Medicaid MUEs for …
WEBJuly 6, 2020 Medically unlikely edits (MUEs) are guidelines regarding the maximum per-patient, per-day units of service for health-insurance billing codes. These guidelines are issued by the National Correct Coding Initiative (NCCI) for the Centers for Medicare and Medicaid Services (CMS) to ensure appropriate utilization of medical services. CMS …
Billing Codes ABA Coding Coalition
WEB97154. Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with two or more patients, each 15 minutes. 97155. Adaptive behavior treatment with protocol modification administered by physician or other qualified health care
Supplemental Guidance Resource ABA Coding Coalition
WEBJanuary 14, 2019. The Steering Committee for the ABA Services Workgroup has prepared the article, Supplemental Guidance on Interpreting and Applying the 2019 CPT Codes for Adaptive Behavior Services, to assist providers, billers, and payers in using the Category I and modified Category III CPT® codes for adaptive behavior services that went
UPDATE: Coalition Advocates for Telehealth
WEBApril 2, 2020 Many providers of applied behavior analysis (ABA) services are facing extreme challenges in delivering those services in person in light of the health and safety risks posed by the COVID-19 outbreak. Like other healthcare providers, our community is scrambling to determine how to use telehealth in order to minimize disruptions to …
Revised Code Conversion Table ABA Coding Coalition
WEBRevised Code Conversion Table. October 19, 2018. In September, we distributed a code conversion table showing the most common HCPCS and 2014 Category III CPT codes that have been used to report applied behavior analysis (ABA) services to health plans, cross-referenced to the 8 new Category I and 2 modified Category III CPT codes that will go
Resources ABA Coding Coalition
WEBCPT Assistant Article for ABA Services. The November 2018 issue of the CPT ® Assistant, a newsletter published by the American Medical Association (AMA), includes an article about the 2019 CPT ® codes for adaptive behavior services that is an essential resource for everyone who bills health plans for ABA services. The AMA has granted the Association …
PREPARING FOR IMPLEMENTATION OF THE 2019 CPT CODES …
WEB1. Enter your current contractual rates in the second column of the table. Enter the new or modified contractual rates in the fourth column. You will need to do the math to convert rates based on the current code’s time increment …
Coalition Receives Optum Clarification on
WEBJanuary 18, 2020 In response to provider outreach, the ABA Coding Coalition contacted Optum/United Behavioral Health in late December to express concern over their proposed 2020 rounding policy regarding the ABA CPT® codes. Optum proposed to require that 10 minutes of services be rendered in order to report using any of those codes. In our […]
Advocacy Efforts ABA Coding Coalition
WEBJuly 2020 Update – CMS publishes two separate MUE data files each quarter containing the MUEs for all healthcare billing codes, one for Medicare and one for Medicaid.These two data files sometimes provide discrepant MUE values for a given CPT code. For instance, for CPT code 97151 the current Medicare MUE is 8 units per day, whereas the Medicaid …
Code Conversion Chart ABA Coding Coalition
WEBThis chart outlines the essential elements of ABA assessment and treatment services and the HCPCS and CPT® codes that have been used for reporting and billing those services. In particular, it shows the conversion of the Category III (temporary) CPT® codes that were issued in 2014 to the Category I and modified Category III codes that took
Modified Health Behavior Assessment and
WEBNovember 25, 2019 The ABA Coding Coalition has learned recently that a number of CPT codes for health behavior assessment and intervention services (96158 – 96171) have been modified for 2020. Those codes are for services to identify and address psychological, behavioral, emotional, cognitive, and interpersonal factors important to the assessment, …
eporting CPT Codes for Telehealth elivery of Adaptive …
WEBUpdated 4/3/2020 21 In light of increased interest in delivering ABA services via telehealth, the ABA Coding Coalition, in collaboration with the Council of Autism Service Providers (CASP) Telehealth Task Force, has adapted the clinical examples from "Supplemental Guidance on Interpreting and Applying the 2019 CPT Codes for Adaptive Behavior
Recent News ABA Coding Coalition
WEBAetna Rescinds Policy Ending Telehealth Coverage for ABA Services in December 2023. December 11, 2023 Earlier this year, Aetna issued a statement indicating that they would be ending telehealth coverage of CPT codes 97151, 97153, 97155, 97156, and 97157 as of December 1, 2023. The Coalition wrote to the company in November to ask that they
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