Behavioral HealthAnthem Blue Cross and Blue Shield | CommercialJanuary 1, 2019

Adaptive behavioral assessment & treatment code changes effective January 1, 2019

New Adaptive Behavior Assessment and Treatment (ABA) Current Procedural Terminology (CPT®) procedure codes have been published by the American Medical Association effective January 1, 2019.  Please begin using the new ABA codes effective with dates of service on or after January 1, 2019, as the old procedure codes will no longer be accepted. It is important to note that the descriptor for all of the new codes represent 15 minute increments of time.

 

Current ABA treatment authorizations that have already been approved through 2019 will be updated to reflect the new codes for the portion of the service that falls in 2019.  Updated authorization letters reflecting the changes to the authorization will be sent to members and providers.  You do not need to call and request that this update to current authorization take place.  Claims submitted for 2019 dates of service should reflect the new codes. 


Old Code(s)

New Code

New Code Description

0359T

97151

Behavior identification assessment, administered by a physician or other qualified healthcare professional, each 15 minutes of the physician's or other qualified healthcare professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan.

0360T 0361T

97152

Behavioral 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 minute.

0362T 0363T

0362T

Behavior identification supporting assessment, each 15 minutes of technicians' time face-to-face with a patient, requiring the following components:

- administered by the physician or other qualified healthcare professional who is on site;

- with the assistance of two or more technicians;

- for a patient who exhibits destructive behavior;

- completed in an environment that is customized to the patient's behavior.

0364T 0365T

97153

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.

0366T 0367T

97154

Group adaptive behavior treatment by protocol, administered by technician, under the direction of a physician or qualified healthcare professional, face-to-face with two or more patients; each 15 minutes.

0368T 0369T

97155

Adaptive behavior treatment by protocol modification, administered by physician or other qualified healthcare professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes.

0370T

97156

Family adaptive behavior treatment guidance, administered by physician or other qualified healthcare professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes.

0371T

97157

Multiple-family group adaptive behavior treatment guidance, administered by physician or other qualified healthcare professional (without the patient present), face-to-face with multiple sets of guardians/caregivers, each 15 minutes.

0372T

97158

Group adaptive behavior treatment with protocol modification, administered by physician or other qualified healthcare professional, face-to-face with multiple patients, each 15 minutes.

0373T 0374T

0373T

Adaptive behavior treatment with protocol modification, each 15 minutes of technicians' time face-to-face with a patient, requiring the following components:

- administered by the physician or other qualified healthcare professional who is on site;

- with the assistance of two or more technicians;

- for a patient who exhibits destructive behavior;

- completed in an environment that is customized to the patient's behavior.

PUBLICATIONS: January 2019 Anthem Maine Provider Newsletter