New CPT codes approved for ABA

New CPT codes are available for applied behavior analysis (ABA) and will go into effect January 1, 2019.

The new CPT codes provide recognition from the American Medical Association (AMA) that ABA is an empirically supported medical intervention.

Proper implementation of the new codes will help secure reliable coverage of ABA services by health benefit plans.

What are CPT codes?

Current Procedural Terminology (CPT) is a listing of terms and identifying codes used to report medical services and bill insurance providers.

They provide a consistent way to communicate medical, surgical, and diagnostic services nationwide among physicians, health care providers, patients, health benefit plans, and other third parties.

CPT codes are issued, maintained, and copyrighted by the American Medical Association (AMA). The CPT Editorial Panel is responsible for maintaining the CPT code set.

Are there different types of CPT codes?

Yes. Category I codes are permanent and accepted by the Centers for Medicare and Medicaid Services (CMS) and other third-party payers.

Category III codes are temporary. They are intended for data collection in emerging fields of technology, services and procedures in order to substantiate widespread use.

Why are the new CPT codes important?

ABA codes were first approved in 2013 and fell under Category III (temporary).

A workgroup was formed shortly after in order to revise the code set. The CPT Steering Committee included Autism Speaks, the Association for Behavior Analysis International, the Association of Professional Behavior Analysts, and the Behavior Analyst Certification Board.

In the fall of 2018, the AMA’s CPT Editorial Panel announced new codes for ABA billing. Eight new Category I CPT codes for ABA services were approved, and two Category III codes were revised.

The new Category I status should lead to fewer denials of coverage based on reasons that ABA is “experimental” or “not medical in nature.”

If you are a provider, please review the resources provided by the CPT Steering Committee.

We have worked on the CPT Steering Committee for multiple years seeking AMA approval of new codes and providing implementation resources.

These educational materials will help providers and consumers understand and prepare to implement the new CPT codes.