Cpt codes for Applied behavior Analysis

2019 CPT? I Codes for

Applied Behavior Analysis:

Adoption, Interpretation, and Next Steps

45th Annual Convention

May 26, 2019

Presented by

Wayne Fisher, Ph.D., and Julie Kornack

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Topics

? Background

? 2019 CPT I Codes

? Descriptors

? Payor Adoption of Codes

? Standardization

? Valuation

? Medically Unlikely Edits

? Next Steps

? Q&A

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Background

? When health insurance began to cover applied behavior analysis as a

medically necessary treatment, billing codes specifically for applied

behavior analysis (ABA) did not exist.

? Payors used a variety of billing codes to pay ABA claims, which caused

confusion and impacted claims data collection.

? In 2012, the Association for Behavior Analysis International (ABAI)

submitted a code change application to the CPT Editorial Panel.

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Timeline of Code Development Process

2010

2012

2013

2014

2015

2016

2017

2017

2019

? ABAI works with American Medical Association to familiarize AMA professional societies with ABA and gain support.

? ABAI submits Code Change Application to CPT Editorial Panel.

? Multidisciplinary work group submits revised application.

? Category III codes take effect July of 2014.

? ABAI forms ABA Services Work Group to develop proposal to modify Category III codes and convert to Category I codes.

? Code Change Application submitted to CPT Editorial Panel.

? ABA Services Work Group presents Code Change Application to CPT Editorial Panel.

? CPT Editorial Panel approves 8 modified codes as Category I and 2 modified codes as CPT III.

? New CPT I and modified CPT III codes take effect January 1, 2019.

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2019 Category I CPT? Codes

? Current Procedural Terminology (CPT) codes are issued,

?

?

copyrighted, and maintained by the American Medical

Association (AMA).

CPT I codes are permanent.

To qualify for a permanent code, procedure or service

must:

?

?

?

?

Be performed by many physicians or other qualified healthcare

professionals (QHP)

Be performed with frequency consistent with intended clinical

use

Be consistent with current medical practice

Demonstrate clinical efficacy documented in literature that

meets rigorous AMA requirements

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