What does Cpt Code 97155 Cover in Aba Therapy?
In ABA therapy, CPT code 97155 covers BCBA-directed protocol modification. This code is used when a Board Certified Behavior Analyst (BCBA) is present to observe the client and make real-time adjustments to the treatment plan.
Key details regarding the coverage of code 97155 include:
- Clinical Purpose: It is used for complex cases where initial protocols require modifications. It helps ensure that treatment goals remain aligned with the child’s progress.
- Provider Type: This service is performed by a BCBA only, rather than a technician.
- Billing Structure: The code is billed in units of 15 minutes, typically ranging from 1 to 6 units per session.
- Reimbursement Rates: Typical rates for this code range between $75 and $150 per unit, depending on the insurer and geographic region.
- Relationship to Other Codes: While 97153 covers the direct one-on-one therapy delivered by a technician, 97155 provides the clinical oversight and infrastructure that makes those hours effective. However, 97155 cannot be billed simultaneously with 97153 for the same time period.
- Documentation Requirements: Providers must supply detailed treatment plan revision notes that justify the medical necessity of the adjustments made during the session.
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