How to: CPT Code 97151 for ABA Therapy
CPT code 97151 is a foundational component of Applied Behavior Analysis (ABA) therapy, covering the initial assessment and development of an individualized treatment plan. Proper documentation and billing for CPT code 97151 ensure compliance and reimbursement while supporting high-quality care.
What Is CPT Code 97151?
CPT code 97151 is used for the behavior identification assessment conducted by a Board Certified Behavior Analyst (BCBA) or other qualified provider. This process includes gathering developmental history, conducting direct and indirect assessments, and developing treatment goals based on findings.
Key aspects of CPT code 97151:
Conducted by a BCBA or qualified provider
Includes interviews, direct observations, and assessment tools
Leads to the creation or modification of a treatment plan
Typically required before initiating ABA therapy sessions
When to Use CPT Code 97151
CPT code 97151 should be billed when an initial or reassessment of a client’s behavior and treatment needs is conducted. It is essential for establishing a baseline and guiding intervention strategies.
Common scenarios for using CPT code 97151:
During the intake assessment for a new ABA client
When a reassessment is required to update treatment goals
If a client experiences significant changes in behavior
Documentation Requirements for CPT Code 97151
Accurate documentation is essential to justify the assessment and support claims. Ensure session notes include:
A detailed summary of assessment activities conducted
Indications of progress toward treatment plan development
The presence of caregivers or parents for at least one session
Creation or updates to treatment goals based on assessment findings
Billing Considerations for CPT Code 97151
To ensure compliance and avoid claim denials, consider the following billing best practices:
Billing Questions:
Was the session not double billed with any other sessions?
Was each individual assessment section no longer than 2 hours?
Was the length of the total assessment no longer than 8 hours?
Was the note signed within 24 hours of the end of the session?
CPT Code 97151 vs. Other ABA CPT Codes
Understanding the differences between CPT code 97151 and other ABA billing codes ensures accurate documentation and billing.
97153: Adaptive behavior treatment by a technician
97155: Direct BCBA involvement with protocol modification
97156: Parent/caregiver training with a BCBA
97157: Group caregiver training
Using the correct CPT code prevents claim rejections and enhances reimbursement.
Conclusion
CPT code 97151 is essential for ABA therapy, serving as the foundation for individualized treatment planning. By ensuring thorough documentation, following billing guidelines, and aligning with payer requirements, ABA provider groups can optimize compliance and maximize reimbursement.
