As you may already know, The Virginia Department of Medical Assistance Services (DMAS) will implement significant changes to the service authorization process for Applied Behavior Analysis (ABA). These changes are part of an ongoing effort to enhance service delivery and ensure compliance with state and federal guidelines.
Here’s what behavior analysts in Virginia should know about the DMAS changes effective October 15, 2025:
- Unbundling of CPT Code 97155
- Providers will no longer be able to submit a single, bundled request for all ABA services under 97155
- Service Authorization requests must specify the exact number of units under each CPT code. (This is not unlike most commercial carrier requirements)
- Required CPT Codes and Specifications
- 97153- Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient
- 97154- Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with two or more patients
- 97155- Adaptive behavior treatment with protocol modification administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient
- 97165- Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s)
- 97157- Multiple-family group adaptive behavior treatment guidance, administered by a physician or other qualified healthcare professional (without the patient present), face-to-face with multiple sets of guardians/caregivers
- 97158- Group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional face-to-face with multiple patients
- 0373T- Adaptive behavior treatment with protocol modification, administered by the physician or other qualified health care 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.
- The ABA assessment codes (97151, 97152, and 0362T) do not require service authorization and are not affected by this change.
- Additional Clarifications
- New language has been included to clarify scheduling expectations for services exceeding 20 hours per week (see updated authorization form below for details)
- Updated documentation standards for services delivered via telemedicine will be in effect- For details on the standards and other changes, see the Revised Appendix D- Page 21
- New Authorization Form
- Download the new form here