What is the Procedure for Billing for ABA Therapy?

Is your applied behavior analysis (ABA) practice suffering from claim denials and delays? Lapses in ABA therapy billing—such as using outdated codebooks, upcoding, unbundling, undercoding, failing to obtain prior authorizations or referrals, or inputting the wrong patient identifier—can negatively affect the financial viability of your practice. Billing errors may not seem like a big deal, but over time, they can get in the way of your ability to deliver reliable care to your clients. Thus it’s crucial to learn how to optimize collections.


Understanding billing for ABA therapy


ABA therapy billing services can help you navigate the process, especially in areas like CPT (current procedural terminology) codes, the primary guidelines for charging therapy services. You also need to know split codes for when a patient sees multiple qualified healthcare professionals during their session.


Here are some of the most important things to note when navigating ABA therapy billing:


CPT codes


There are 16 CPT codes, and they are divided into two main categories. The first category of codes mirrors assessment, the initial stage of creating an ABA therapy plan. Code 0359T (initial behavior identification assessment) has two follow-up categories: (1) observational and (2) exposure behavioral assessments.


These two steps can be further divided into two distinct codes, depending on the length of the treatment session. The observational component can be billed using code 0360T for sessions lasting less than 30 minutes and under 0361T for longer sessions. The same applies to the exposure behavioral assessment stage and codes 0362T and 0363T.


Codes 0364T to 0374T cover various treatment services, while 0370T to 0372T cover non-timed treatments. The final codes (0373T and 0374T) are related to a single stage of treatment billed differently, depending on the duration of every visit.


Different CPT codes for professionals and paraprofessionals


Only a qualified healthcare provider can submit ABA therapy billing, but in some cases, paraprofessionals/support staff are involved in the treatment. Treatment codes relating to technicians may apply in these cases. Codes 0364T to 0367T, 0374T, and 0373T indicate that technicians worked directly with the patient. The remaining codes (0368T to 0372T) cover treatment provided by the qualified healthcare provider in charge of the team involved in the treatment.

Split coding for team therapy


If multiple therapists work with a patient, they cannot all claim the total time covered. There are two options: The therapist who took the leading role in the treatment can bill for the entire session, or all the therapists can split the time into separate billing codes.


Eliminate the guesswork
Prevent errors and increase efficiency by outsourcing ABA therapy billing to a reputable medical billing company that can handle your entire revenue cycle management process. Doing this can also boost your revenue while allowing you to focus on providing excellent care.


About the Author:


Thomas John leads a global team of 500 employees in 3 locations as the President & CEO of Plutus Health providing, RPA powered revenue cycle management services to healthcare organizations across 22 states. Plutus Health Inc. is a 15-year-old full-cycle RCM firm specializing in medical coding & billing, denial management, credentialing, prior authorizations, AR follow-up for both medical and behavioral health specialties. As the industry experts in revenue cycle management solutions, they’ve created a unique process that combines machine learning and robotic process automation to address the clients’ most frustrating problems.

Comments are closed