How Will New Billing Codes Affect Aba Services?
Anthony Porcelli, Director of Billing Services for Rethink Behavioral Health, had the pleasure of attending Dr. Wayne Fisher's workshop on thenew Category 1 CPT Codes for ABA Services, which will be effective Jan 1, 2019.
I split up the workshop into iii sections:
- Interpreting the new Category 1 CPT Codes
- Suggestions to help valuate the codes when negotiating rates with payers
- The work was undertaken to go the new Category one CPT Codes accustomed past the American Medical Association (AMA)
Theii great advantages I meet with the new codes are that they are cleaved upwardly into xv-minute units to let for more than efficient billing and the ongoing codes are no longer needed.
A quick crosswalk for the more commonly used codes is listed below and more than detailed descriptions can be plant here.
| Erstwhile Category iii Lawmaking | New Category 1 Code |
| 0359T | 97151 |
| 0360T – 0361T | 97152 |
| 0364T – 0365T | 97153 |
| 0368T – 0369T | 97155 |
| 0370T | 97156 |
| 0371T | 97157 |
A central talking point of the workshop involvedvaluating the codes when negotiating rates with payers.
When negotiating rates it is important to demonstrate to payers the amount of piece of work that goes into each service.
For instance, when negotiating rates for a technician appointment (0364T – 0365T) providers should mention the training that is involved between the BCBA and the tech earlier the appointment, the work that goes on during the actual appointment, and the interpretation of information and session notes created later on.
To practice this, Dr. Fisher suggested that providers consider each CPT Code in 3 parts:
- Pre-Service
- Intra-Service
- Post-Service
Pre-Service includes everything that goes on before the appointment takes place such every bit training staff and writing protocols.
Intra-Service consists of the work that goes on during the actual appointment itself while Post-Service is the work that happens afterwards a session is completed such as writing progress notes and reviewing data.
By doing this, the provider can adequately describe the total telescopic of piece of work that goes into each appointment.
A farther example is provided below for what goes into a Back up/Technician Appointment:
0364T – 0365T
Pre-Service Work
- BCBA: Trains a technician to perform the service.
- RBT: Attends trainings with BCBA. Reviews patient medical records. Creates materials for sessions.
Intra-Service Work
- RBT: Works with client based on protocols created by BCBA.
Postal service-Service
- RBT: Writes session notes. Communicates with BCBA as needed about sessions.
- BCBA: Reviews/Approves session notes. Interprets information. Updates treatment plan.
Next Steps
The final slice of the workshop involved discussion on the adjacent steps that Dr. Fisher and his grouping would be working on involving the new Category i CPT Codes.
The get-go order of business for the group is releasing a "Tool Kit" for providers to help valuate their services when getting ready to negotiate with payers.
Dr. Fisher and his team will too work with the AMA to accost the issue of billing for both the RBT and BCBA during overlapping service times.
He believes providers should be able to bill for both services concurrently considering the responsibilities of each professional during the common session are unlike.
In Summary
In summation, I believe the new codes will positively touch on the ABA world and simplify the billing process.
Since the ongoing codes take been eliminated, there volition be less line errors during billing, leading to faster payments and less back-and-forth interaction with the insurance companies so that providers tin spend more time with their clients.
Also, since the new codes take been assigned category i condition, I hope that payers volition exist more uniform with their interpretations of their use which will besides make for improved efficiency in billing.
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Source: https://www.rethinkbehavioralhealth.com/bh/blogs/new-category-1-cpt-codes-for-applied-behavior-analysis-aba-services/
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