Adaptive behavior treatment codes are billed in 15-minute units, and each code has its own rules about who can render it and how it must be documented.
The core codes
97151 covers behavior identification assessment by a qualified healthcare professional. 97153 is adaptive behavior treatment by protocol, usually delivered by an RBT. 97155 is protocol modification by the BCBA, and 97156 is family adaptive behavior treatment guidance.
- 97151 to Assessment (QHP)
- 97152 to Supporting assessment (technician)
- 97153 to Treatment by protocol (technician)
- 97155 to Protocol modification (QHP)
- 97156 to Family guidance (QHP)
Authorization is everything
Most payers authorize ABA by code and unit for a fixed period. Track used vs. authorized units weekly, and start re-authorization at least 30 days before expiration.
