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:

1. Was the session not double billed with any other sessions?
2. Was each individual assessment section no longer than 2 hours?
3. Was the length of the total assessment no longer than 8 hours?
4. 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.