Understanding and Applying CPT Code 97153 for ABA Therapy

CPT code 97153 is a fundamental billing code in Applied Behavior Analysis (ABA) therapy, covering one-on-one adaptive behavior treatment implemented by a technician under the supervision of a Board Certified Behavior Analyst (BCBA). Properly utilizing CPT code 97153 ensures accurate billing, compliance, and reimbursement for ABA provider groups.

What Is CPT Code 97153?

CPT code 97153 is used when a behavior technician delivers individualized ABA therapy to a client based on a treatment plan designed by a BCBA. The technician follows prescribed interventions, collecting data on progress while maintaining direct interaction with the client.

Key aspects of CPT code 97153:

• One-on-one direct therapy by a behavior technician
• Supervised by a BCBA but does not require real-time BCBA involvement
• Implementation of pre-designed behavior intervention plans
• Typically used in ongoing ABA treatment sessions

When to Use CPT Code 97153

CPT code 97153 should be billed when an ABA technician provides therapy as outlined in the treatment plan without modifying protocols in real-time. This differentiates it from CPT code 97155, where the BCBA actively adjusts treatment interventions during the session.

Common scenarios for using CPT code 97153:

• When a behavior technician implements a structured ABA program
• When a client requires repeated practice of targeted behaviors
• In routine therapy sessions aimed at skill-building and behavior reduction

Documentation Requirements for CPT Code 97153

Accurate documentation is crucial for claims approval and compliance with payer requirements. Session notes for CPT code 97153 should include:

• Specific goals targeted during the session
• Data collected on the client’s response to interventions
• The duration of the session and the techniques used
• Confirmation that the session followed the BCBA-approved treatment plan

Failure to document these details may lead to claim denials or audits from payers.

CPT Code 97153 Reimbursement Considerations

Reimbursement for CPT code 97153 varies by payer and state. Insurance companies often require prior authorization and may impose limits on the number of hours that can be billed per week.

Maximizing reimbursement for CPT code 97153:

• Confirm authorization requirements with each payer
• Maintain clear and accurate session documentation
• Ensure that behavior technicians operate under BCBA supervision
• Align treatment plans with medical necessity criteria

CPT Code 97153 vs. Other ABA CPT Codes

Understanding how CPT code 97153 differs from other ABA codes is essential for correct billing:

• 97155: Direct therapy with protocol modification by a BCBA
• 97154: Group adaptive behavior treatment by a technician
• 97156: Caregiver training with a BCBA
• 97157: Group caregiver training sessions

Ensuring correct code usage reduces claim rejections and helps provider groups optimize revenue cycle management.

Conclusion

CPT code 97153 is a key component of ABA therapy billing, supporting structured, one-on-one treatment sessions provided by technicians. By ensuring accurate documentation, following payer guidelines, and distinguishing this code from others, ABA provider groups can improve compliance and secure appropriate reimbursement.

For more insights on ABA documentation, download our ABA QA Guide.