New CPT Codes for ABA Billing

November 1, 2018

New CPT codes for ABA billing have been announced by the American Medical Association CPT Editorial Panel. These codes will take effect on January 1, 2019.

Autism Speaks has worked for multiple years on the CPT Steering Committee seeking AMA approval of these new codes. We are happy to join the committee in helping you understand and implement the new CPT codes for ABA services.

 

What are CPT codes?

Current Procedural Terminology (CPT) is a listing of terms and identifying codes used to report medical services and to bill insurance providers. CPT codes are issued and maintained by the American Medical Association (AMA).

CPT codes are classified either as Category I (permanent) or Category III (temporary).

 

How have the CPT codes changed?

ABA codes were first approved in 2013 and fell under Category III (temporary).

A workgroup was formed shortly after in order to revise the code set. The CPT Steering Committee included Autism Speaks, the Association for Behavior Analysis International, the Association of Professional Behavior Analysts, and the Behavior Analyst Certification Board.

In the fall of 2018, the new codes for ABA billing were announced with important changes:

  • Eight new Category I CPT (permanent) codes for ABA services were approved.
  • Two Category III (temporary) codes were revised.
  • There are no more add-on codes (which required using one code for the first 30 minutes and different codes thereafter).
  • All codes use uniform time increments (time is billed in 15-minute increments)

Review the CPT Code Conversion Chart for a full and detailed explanation.

 

How can your practice benefit from the new CPT codes?

The old ABA codes fell under Category III (temporary). Most of the new codes are now under Category I (permanent).

The new Category I status should lead to fewer denials of coverage based on reasons that ABA is “experimental,” “unproven,” or “not medical in nature.”

 

What effect should you see with your payor?

It may take several months for your payor to adapt the new CPT codes. It is possible that your revenue stream may be disrupted.

You may also need to negotiate new rates with your payors since the new codes are billed in 15-minute increments whereas many of the old, Category III codes were billed in 30-minute increments.

Engage with payers as soon as possible!

Check out our suggestions for providers as you review your contracts, calculate the value of your services, and prepare to negotiate rates.

 

How can you prepare for CPT code implementation?

We hope the following resources and information provided by the CPT Steering Committee will help you prepare for the implementation of the new codes.

It is essential that you obtain additional resources, beyond what we have provided, to ensure compliance with AMA coding and reimbursement rules.

Important resources include the 2019 CPT code book and the forthcoming CPT Assistant article which will be published later this fall. They can be purchased from the AMA store.