2024/9/11
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Posted by Provider Relations
Reminder: Initial and re-assessment treatment planning activities should align with the description of code 97151 (below). Indirect services, such as ongoing treatment planning, are not separate billable services under the current CPT codes. Ongoing treatment planning is bundled with treatment codes 97155 and 97156.
Although this is not new guidance, Fidelis Care will be enforcing these guidelines in Utilization Review and Claims in an effort to better align with the billing expectation guidelines.
| 97151 | Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician’s or other qualified health care professional’s time face to face with patient/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan. |
| 97155 | Adaptive behavior treatment with protocol modification, administered by a physician or other qualified health care professional, which may include simultaneous direction of a technician, face-to-face with one patient, every 15 minutes. |
| 97156 | Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes. |
To better understand the CPT codes for Applied Behavior Analysis, please reference the eMedNY Provider manual listed below:
https://www.emedny.org/ProviderManuals/ABA/PDFS/ABA_Policy.pdf
For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please click here.