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New crosswalk available for CPT codes from ABAI

Category: Billing, Posted on: 5/18/2016 1:40:09 PM

As many here are already aware, a CPT® coding structure to report adaptive behavior assessment and treatment services to health insurance plans became effective July 1, 2014. This includes 15 new Category III codes: 0359T, 0360T, 0361T, 0362T, 0364T, 0365T, 0366T, 0367T, 0368T, 0369T, 0370T, 0371T, 0372T, 0373T, and 0374T. About a year ago, a workgroup was formed to collect information about utilization of that code set for reporting applied behavior analysis (ABA) services in preparation for submitting a Code Change Proposal to the American Medical Association CPT Editorial Panel. The workgroup comprises representatives of the Association for Behavior Analysis International (ABAI), Association of Professional Behavior Analysts (APBA), Autism Speaks, and the Behavior Analyst Certification Board (BACB), as well as providers and health plans. Input is also being sought from other stakeholder societies, which includes specialties such as speech-language pathology, occupational therapy, pediatrics, and others.

This workgroup has learned that some payers are utilizing a blend of HCPCS codes with the new Category III CPT codes for reporting ABA services, while others are not utilizing the Category III codes at all. Over the past year, feedback from payers and providers across the country indicated that crosswalk information would be extremely useful for achieving consistency in utilization and implementation of–and ultimately in establishing valuation and reimbursement rates for–the new codes.

A crosswalk chart is available (https://www.abainternational.org/media/109996/Crosswalk.pdf). It indicates the most common HCPCS and CPT codes that have been or are being utilized by payers to report ABA services. It is organized by the essential elements of ABA services, as indicated by the BACB. Those services include assessment and reassessment, treatment plan development and revision, direct treatment of individual clients, supervision or direction of technicians by a professional behavior analyst or other Qualified Healthcare Professional (QHCP), family or caregiver training, and group treatment. The crosswalk chart also indicates which personnel must attend each service to report the new CPT codes, as well as applicable time increments.

We hope the crosswalk information will foster a greater understanding of how the Category III codes were intended to be reported and encourage uniform reporting of ABA services across providers, payers, and states. If you have comments or questions or need additional information, please contact Jenna Minton at mintonhealthcarestrategies@gmail.com