CPT Code 97153 vs. 97155: Key Differences and Best Practices for ABA Therapy
Understanding the differences between CPT code 97153 and CPT code 97155 is essential for proper ABA therapy billing and documentation. Both codes are used for adaptive behavior treatment but apply to different service structures. Knowing when to use each code ensures compliance, prevents claim denials, and maximizes reimbursement.
What Is CPT Code 97153?
CPT code 97153 is used for one-on-one adaptive behavior treatment delivered by a behavior technician under the supervision of a Board Certified Behavior Analyst (BCBA). This code is billed for direct implementation of an intervention plan without real-time modifications.
Key aspects of CPT 97153:
Delivered by a behavior technician
Supervised by a BCBA but without direct BCBA involvement in real time
Follows a pre-designed treatment plan
Typically involves skill-building and behavioral interventions
What Is CPT Code 97155?
CPT code 97155 is used when a BCBA is directly modifying a treatment protocol based on real-time observation and interaction with the client.
Key aspects of CPT 97155:
Delivered by a BCBA or a qualified healthcare professional
Includes active assessment and real-time modifications to treatment
Focuses on adapting strategies based on client response
Can be conducted with or without a technician present
Key Differences Between CPT 97153 and 97155
Who Provides the Service?
CPT 97153: Behavior Technician
CPT 97155: BCBA or other qualified professional
BCBA Involvement
CPT 97153: Supervision but not direct engagement
CPT 97155: Direct involvement and protocol modification
Purpose
CPT 97153: Implementation of a pre-established treatment plan
CPT 97155: Active assessment and adjustment of interventions
Real-Time Plan Adjustments
CPT 97153: No
CPT 97155: Yes
Who Is Present?
CPT 97153: Client and technician
CPT 97155: BCBA with or without a technician
When to Use CPT 97153 vs. 97155
Use CPT 97153 when a technician is implementing interventions as outlined in the treatment plan without modifications.
Use CPT 97155 when a BCBA is modifying or assessing the intervention plan in real time based on client behavior.
Documentation Requirements for CPT 97153 and 97155
CPT 97153 Documentation Checklist:
Goals targeted during the session
Data collection on client responses
Confirmation that the technician followed the BCBA-approved plan
Duration of the session and interventions used
CPT 97155 Documentation Checklist:
Modifications made to the treatment plan
Justification for real-time adjustments
Data showing the client’s response to new strategies
BCBA’s direct involvement in the session
Billing and Reimbursement Considerations
Insurance payers may have specific rules regarding how often CPT 97155 can be billed in comparison to CPT 97153. Many require:
Prior authorization for CPT 97155
Session length limitations for CPT 97153
Clear documentation of BCBA involvement in CPT 97155
Conclusion
Using CPT code 97153 and CPT code 97155 correctly ensures compliance and maximizes reimbursement. 97153applies when a behavior technician implements interventions, while 97155 is used when a BCBA modifies the treatment plan in real time.
By maintaining accurate documentation and understanding payer requirements, ABA provider groups can optimize their revenue cycle management and deliver high-quality services. For more insights on ABA CPT codes, explore our blog series on session note documentation!
