There are a lot of things to keep in order when it comes to running your own ABA therapy practice. From keeping your credentials and certifications up-to-date to managing your staff, plus all the record-keeping that must be taken care of, there is more than enough to make anyone feel a bit overwhelmed at times.
When you’re in need of support, the experts at Amvik Solutions have just the experience and skills to help you manage some of the finer details of your practice, allowing you to focus your energy on what matters most – providing quality ABA therapy services to families.
A couple of different topics regularly come up when we work with ABA professionals because they require a constant effort to keep up with.
Two of those frequent topics discussed are current procedural terminology (CPT) codes, which are the primary guidelines for billing for therapy services, as well as split codes, which arise when a patient receives treatment from more than one qualified healthcare professional (QHCP) during a session.
There are a few general things to keep in mind when working through these billing aspects.
1. The 16 CPT codes (0359T-0374T) are divided into two general categories.
The first category of codes mirrors the first stage of developing an ABA therapy plan: assessment. The initial behavior identification assessment, identified by code 0359T, has two follow-up categories, observational and exposure behavioral assessments.
These two steps in the assessment process can each be divided into two separate codes, depending on how long the treatment session lasts. The observational component can be billed under code 0360T for any session that lasts less than 30 min and under 0361T for any that goes longer.
The same holds true for the exposure behavioral assessment stage and code numbers 0362T and 0363T.
The remaining codes, from 0364T to 0374T, all cover various treatment services. Like the steps in the assessment stage, some treatments can be billed under two separate codes depending on the length of the session.
Three codes, 0370T-0372T, all cover treatments that are not subject to being timed. Two of these, 0370T and 0371T, are treatments that involve providing guidance to families in both single-family and multiple family settings, without patients being present.
The final two codes, 0373T and 0374T, are tied to a single stage of treatment that is billed differently depending on the amount of time that goes into each visit.
This step, exposure adaptive behavior treatment with protocol modification, gets billed under the former code for all sessions that last less than an hour. For every additional half hour, the latter code is used for billing purposes.
2. The person performing a treatment service is another coding indicator.
While only a QHCP can submit billing for ABA therapy, there is a number of support staff that play a part in the treatment of any given patient. The different CPT codes used in ABA therapy billing do have direct correlations to the professional or paraprofessional involved.
The initial assessment, under code 0359T, is performed by a QHCP. The remainder of the assessment procedures and their corresponding CPT codes are all carried out by a technician.
Treatment codes that are related to the technicians in therapy, 0364T-0367T, 0373T and 0374T, all involve direct work with patients. There are no billing codes concerning the families of patients and technicians.
All remaining codes, 0368T-0372T, cover treatment given by the QHCP in charge of the team attached to each patient.
As a corollary of the information above, the only treatment steps that involve family members or multiple patients’ families that are billed are ones carried out by a QHCP.
3. Split codes cannot result in “double billing”.
Keeping track of all the details involved with correctly billing according to the CPT codes can be difficult enough when there is just one type of treatment that a patient gets in a given session.
Multiple treatments involve not only the possibility of different CPT codes but also coordination between professionals who may not always work with the same organization.
Double billing is when more than one provider works with a patient during a given time frame and they both bill the patient for the full amount of time. There are two general paths that can be taken to resolve this type of situation.
Whether there is a “team therapy” approach that is being taken for a particular patient or not, the multiple therapists who worked with the patient can’t all claim the time covered. One option is for a single therapist to bill for the entirety of the session, if it can be decided that they were in a leading role and others acted in more of a support role.
The second option involves splitting the time evenly into separate billing codes. For example, a session involving a Speech Language Pathology (SLP) and an ABA therapist that lasts 60 minutes, would be divided into 30-minute sections for each treatment.
Amvik Solutions is here to alleviate the potential pressures of dealing with billing and provide the support you need so your staff’s energies can be dedicated to your patients.
There are many additional details that need to be considered when coding and billing, details that exist with the risk of change. Keeping abreast of the variations can be time-consuming and mistakes can cause stress and detract from other areas of your practice.
Don’t wait. Contact us today at (805) 277-3392 for help sorting out your practice’s billing and coding needs.