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Billing change for assessments and reassessments
December 24, 2018

This article is for licensed applied behavioral analysts, early intervention specialists, clinical psychologists, and community mental health centers

Based on feedback from licensed applied behavioral analysts about our News Alert published on October 23, 2018, we have changed the way we will reimburse and authorize initial assessment (97151) and re-assessment (97151-52) codes. We have eliminated CPT code 97151 with modifier 52 from the licensed applied behavioral analyst fee schedule. Therefore, effective January 1, 2019:

  • You will request authorization for initial assessment and re-assessment under CPT code 97151 only.
  • The unit maximum for 97151 (whether for initial assessment or re-assessment) will be a total of 32 units per 6-month period (180 days) per licensed applied behavioral analyst group or business entity.

This change should make the request for prior authorizations and billing less complicated. To read your News Alert, please log in and go to News>Claims, coding, payment and scroll down to the News Alert dated October 23, 2018.

Explanation about billing for program planning
There is still confusion over the program planning billing and reimbursement that we communicated in our November 30 news article. Because the description for CPT codes 97155, 97156, 97157, and 97158 include program planning and development, we will not provide reimbursement for code G9012. The fee schedule for codes 97155 - 97158 has been calculated to include program planning and development. To review your fee schedule, please log in and go to fee Office resources> Billing & reimbursement>Fee schedules.