Get ready for the 2019 CPT® codes for Adaptive Behavior Analysis. On September 5, 2018 the American Medical Association CPT Editorial Panel announced new CPT codes, including 10 new codes for ABA billing. These codes will take effect and be available for use effective January 1, 2019, but payors may implement them over various time schedules.

These new billing codes matter — especially since reimbursement for your hard work with clients depends on correct billing procedures. At CentralReach, we want to support you through this transition so you can continue to deliver superior ABA services. The following FAQs and resources were developed to jumpstart your preparation efforts and help you successfully adopt these new CPT codes.

Let’s get started!

What are CPT codes?

The Current Procedural Terminology (CPT) is a listing of terms and identifying codes used to report services and bill medical insurance providers. The CPT codes are issued, maintained, and copyrighted by the American Medical Association (AMA). Category I codes are permanent, and Category III codes are temporary (to allow for data collection in emerging fields).

What are the key differences between the new and old CPT codes for ABA?

  • The set of codes is smaller (10 new versus 16 old)
  • All codes are timed (minimum 15 minute increments)
  • There are NO codes for indirect services. However, there may be allowance under code 97151 to “analyze and interpret” and to “prepare.”

How might my practice benefit from the new CPT codes?

The ABA codes previously fell under Category III (temporary). Now, most will be elevated to Category I (permanent). Status as Category I codes should lead to fewer denials of coverage due to rationale such as “experimental” or “unproven” or “not medically necessary.”

Also, HIPAA requires the implementation and use of Category I codes, so reimbursement may be easier.

How might the new CPT codes affect my revenue stream?

Implementation of the new codes may take a quarter or longer, depending on the payor. Your revenue stream may be disrupted. Additionally, you may need to negotiate new rates with your payors, since the codes do not cover indirect services.

How should I prepare for CPT code implementation?

It may take several months for your payor to adapt the new CPT codes, but you can get a jumpstart by taking the following steps:

  1. Read the codes. While we recommend reading the full AMA CPT codes, the BACB provides a helpful crosswalk between the old and new codes. All 16 old codes were Category III codes, which were temporary. The 10 new codes include Category I codes (8 permanent codes) and Category III codes (2 temporary codes).
  2. Attend a local or online training. Ensure your billing and clinical teams understand the services included under each code. Consider external trainings and resources such as Q&A sessions by the Association for Professional Behavior Analysis, and this recorded webinar by the Behavioral Health Center of Excellence.
  3. Get in constant contact with your payors. Your provider network reps will be the most valuable point of contact, as they are employed by the insurance carriers and will have access to information specific to that carrier. Use CentralReach’s CPT Payor Checklist, a resource designed to help you get prepared to discuss key information about your payors’ timelines, authorizations, and new unit rates.
  4. Continue to read your CentralReach emails. Look for a future webinar, implementation guide, and other aids to assist you with setting up the new CPT codes in your CentralReach account.  

Even though the implementation of the new CPT codes may create some challenges, CentralReach cares about your success and wants to see your practice thrive. Our platform has the flexibility and tools needed for you to smoothly implement these codes based on each of your payors’ specific requirements and timelines. Stay tuned for more information and resources on setting up your practice for 2019 CPT billing success!