As you may know, the American Medical Association (AMA) has approved eight new Category I and two revised Category III CPT® codes to report applied behavior analysis (ABA) services (termed “adaptive behavior assessment and treatment services”) to health insurance plans. Those codes take effect January 1, 2019. The new codes resulted from a code change application submitted to the AMA CPT Editorial Panel in 2017 by the Steering Committee for a national workgroup comprising representatives of the Association for Behavior Analysis International (ABAI), Association of Professional Behavior Analysts (APBA), Autism Speaks, Behavior Analyst Certification Board (BACB), CPT consultants, providers, and representatives of some health plans. In preparing the code change application, the Steering Committee collected extensive information about utilization of the Category III CPT code set that has been used for reporting ABA services since 2014. We also sought input from other stakeholder societies.
To help payers and providers achieve consistency in utilization and implementation of the new codes, we have prepared a coding conversion crosswalk, available here and in the Members Only section of the APBA website under Health Insurance. It indicates the most common HCPCS and 2014 Category III CPT codes that have been or are being used by payers to report ABA services, and cross references those older codes to the 2019 Category I and III CPT codes. The crosswalk is organized by the essential elements of ABA services: assessment and reassessment, treatment plan development and revision, direct treatment of individual clients, direction of technicians by a professional behavior analyst or other qualified healthcare professional (QHP), family or caregiver training, and group treatment. For each new code, the crosswalk also indicates which personnel must attend each service in order to bill for that service as well as applicable time increments.
We hope this information will foster an understanding of how the 2019 CPT codes are 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 our CPT coding consultant JennaMinton, Esq. at email@example.com.
Travis Thompson, Association for Behavior Analysis International
Gina Green, Association of Professional Behavior Analysts
James E. Carr, Behavior Analyst Certification Board
Lorri Unumb, Autism Speaks
Jenna W. Minton, Minton Healthcare Strategies (CPT Consultant)