How Many Units of 97153 are Typical per Session?
For CPT code 97153, which covers direct one-on-one ABA treatment delivered by a technician, the number of units billed per session typically ranges from one to eight units.
Since this code is billed in 15-minute increments, a session consisting of one to eight units translates to a duration of 15 minutes to two hours of direct therapy.
It is important to note the following regarding unit allocations:
- Authorized Units: The specific number of units allowed for your child is determined by your insurance carrier during the authorization process. This is based on the medical necessity and the weekly hour recommendations outlined in the BCBA’s comprehensive assessment.
- Daily Caps: While one to eight units is typical, many insurance providers cap services at a maximum of eight units per day, though these limits vary significantly between different insurance plans.
- Documentation: To justify these units for reimbursement, providers must maintain detailed session notes. These notes must include exact start and end times and demonstrate that the time was spent strictly implementing the behavior protocol.
Because insurance coverage and unit limits vary by plan, it is recommended to verify your specific benefits with your insurer or consult your BCBA for individualized recommendations.
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