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  • More CPT Code Information – Provider Rates

    Posted on November 4, 2018 by in Private Practice

    APBA sent more information about provider rates.  The AMA has determined that they will be set by the insurance companies.  Now is a good time to negotiate!  APBA has information on their site about negotiation tactics for their members – 

    Here is the email sent on 11/4/18:

    On November 1, 2018 the Centers for Medicare & Medicaid Services (CMS) released the 2019 Medicare Physician Fee Schedule (MPFS) final rule.  It includes the following statement regarding the new Category I and revised Category III CPT codes for adaptive behavior services:

    We note that we intended to assign a contractor price status in the Addendum B file of the proposed rule for the following CPT codes that describe adaptive behavior analysis services: CPT codes 97151, 97152, 97153, 97154, 97155, 97156, 97157, and 97158. These codes are formerly contractor-priced Category III CPT codes that were converted to Category I for CY 2019. We inadvertently excluded these codes in the Addendum B file of the proposed rule, and have updated the Addendum B file for this final rule.

    “Contractor price status” means that the new CPT codes will be priced by each payor for 2019.  As always, providers should be prepared to negotiate reimbursement rates through the contracting process. Log in to and go to Members Only/Health Insurance Coverage to access a set of suggestions we have developed to assist providers with that process and other aspects of the transition to the new codes.


    The ABA Services Workgroup Steering Committee:

    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)

One Response so far.

  1. CDEvanko says:

    Note that some insurance companies have come out with statements on the changes. See this information from Cigna:

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