Specialty
ABA therapy billing services
ABA therapy billing services turn hours of technician and analyst time into claims that match an authorization measured in 15-minute units per code, under rules about who can bill, who must supervise, and which services may overlap.
See where claims are getting stuck. No patient data needed.
Remitwright gives ABA practices a dedicated biller who tracks units against authorizations week by week, keeps the credential modifiers and rendering providers right for each plan, and works denials to the cause instead of the symptom.
ABA therapy billing is one of Remitwright's specialty billing services, each set out with its own code families, denial reasons and payer rules.
Last reviewed by the Remitwright billing team. Editorial policy
- 0373T
- 97151
- 97152
Denials
Why ABA therapy claims get denied
The reasons that come up most on ABA therapy remittances, with the usual cause and the fix. Code explanations are our own; the official list is maintained by X12.
| Code | Reason | Usual cause | The fix |
|---|---|---|---|
| CO-197 | Authorization absent or exceeded | Units billed past the authorized number for the code or the period, often because the authorization covers several codes and one ran out first | Units tracked per code per authorization on the schedule, with a weekly countdown and renewal requested before the last units are used |
| CO-151 | Units exceed what the payer allows per day | A long session billed as more units than the payer's daily limit for that code | Daily unit ceilings checked per payer before release, with the session split or documented as the plan requires |
| CO-18 | Duplicate or overlapping service | Technician and analyst sessions billed for the same time without the concurrent-service rules being met, or two technicians overlapping | Start and stop times on every session and a rule that flags overlaps before submission |
| CO-16 | Claim lacks information | Rendering provider, supervising provider, credential modifier or taxonomy missing or wrong for the plan | Provider setup per plan, including technicians where the plan requires them on the claim |
| CO-50 | Not medically necessary | Treatment plan out of date, goals not measurable, or the diagnosis not supported by a diagnostic evaluation the plan recognizes | Reassessment and plan update dates on the calendar, with the plan written to the payer's criteria |
| CO-29 | Past timely filing | Claims held while waiting for an authorization that arrived late, then filed past the window | Authorization requested early enough that claims are not held; where the plan back-dates, claims filed with the authorization number as soon as it issues |
Codes
Common ABA therapy codes and modifiers
Code families by number with our own one-line explanations. CPT descriptors belong to the AMA and are not reproduced here.
| Codes | What the family covers |
|---|---|
| 0373T | Adaptive behavior treatment with protocol modification for severe destructive behavior, a category III code that many payers handle differently |
| 97151 | Behavior identification assessment by the behavior analyst, billed in 15-minute units, including the time spent analyzing data and writing the plan where the payer allows it |
| 97152 | Supporting assessment by a technician under the analyst's direction, in 15-minute units |
| 97153 | Adaptive behavior treatment by protocol, delivered by a technician face to face with one patient; the code most of an ABA practice's hours go to |
| 97154, 97158 | Group adaptive behavior treatment by protocol, by a technician, and group treatment with protocol modification by the analyst |
| 97155 | Treatment with protocol modification by the analyst, which may be delivered concurrently with the technician's session when the analyst is directing it |
| 97156, 97157 | Family adaptive behavior guidance, individual and group, with or without the patient present |
Modifiers that matter
- HO, HM, HN and other credential modifiers
- Medicaid and some commercial plans identify the rendering clinician's level, such as analyst, assistant or technician, with a modifier that changes the rate; which letters apply is set by each plan.
- 95
- Telehealth, usually for family guidance and some supervision, where the plan allows ABA services by video.
- 59 or XE
- Two services on the same day that the payer would otherwise bundle, such as a technician session and a family guidance session in separate time blocks.
- U modifiers
- State-defined modifiers that some Medicaid programs use to mark ABA services, the setting or the provider type; the state manual lists them.
Payers
Payer notes
- MedicaidChildren and young adults under 21 are entitled under EPSDT to medically necessary treatment services that correct or ameliorate a condition found on screening, which is the basis on which state Medicaid programs cover ABA; each state sets its own codes, modifiers, authorization process and provider qualifications.1
- Medicare and commercial plansThe NCCI medically unlikely edits set a maximum number of units per code per day, and procedure-to-procedure edits govern which ABA codes may be billed together on the same date; plans that adopt the edits deny the excess rather than reduce it.2
- All payersTelehealth ABA services, where a plan allows them, carry the place of service from the CMS code set with 10 for the patient's home, and the plan's own rule on whether family guidance and supervision qualify.3
Authorizations
Every ABA authorization is a table: codes down the side, units across, with a start and end date. The units run out at different rates, and a renewal needs an updated treatment plan with data showing progress against measurable goals. Your biller tracks units used against units authorized for each code every week, flags the code that will run out first, and requests the renewal with the plan update far enough ahead of the end date for the plan's turnaround, because almost no plan back-dates an ABA authorization.
Documentation traps
- Session notes without start and stop times, the setting and the people present, which is what an auditor checks against the units billed
- Technician sessions without the analyst's supervision documented at the frequency the plan requires, which turns paid claims into a recoupment
- Treatment plan goals that are not measurable, so the reassessment cannot show progress and the renewal is refused
- Concurrent analyst and technician services without a note that shows the analyst was directing the technician during the overlap
What a specialist checks
Specialist or generalist for ABA therapy billing?
A generalist biller can enter an ABA therapy claim. Whether it pays turns on three things specific to ABA therapy billing, and a specialty-aware biller checks each one.
Code families
Each family billed with what the chart has to show for it.
- 0373T
- 97151
- 97152
Modifiers
Applied only where the note supports them, line by line.
- HO, HM, HN and other credential modifiers
- 95
- 59 or XE
If you are moving from another billing company or an in-house biller, switching billing companies follows a plan: the old and new processes run side by side until the new one is proven, and every login and every ABA therapy claim stays in your name.
What we handle
What we handle for ABA therapy providers
- Prior authorizationAuths requested, tracked, attached to claims
- CredentialingEnrollment, CAQH and PECOS kept current
- Charge entryEvery encounter captured, nothing left unbilled
- Claim submissionScrubbed, submitted and tracked to acceptance
- Denial managementEvery denial read, worked and appealed
- Eligibility verificationCoverage and benefits checked before visits
A dedicated biller with named cover, working inside your system and reporting to you on one written page. How it works sets out the five stages.
Worked example: the code that runs out first
A hypothetical ABA practice holds a six-month authorization for one child: 1,040 units of 97153, 120 units of 97155, 48 units of 97156 and a reassessment at the end. In week nine the biller's countdown shows 97153 running ahead of plan, because the family added Saturday sessions, and on track to run out about four weeks before the end date while the other codes still have balance. The biller flags it to the clinical director, the analyst updates the treatment plan with progress data, and a request for additional 97153 units, with the updated plan, goes to the plan with time left for its review. Every session stays inside authorized units, and no week of technician treatment is delivered past the authorization and written off.
Software
Systems ABA therapy providers usually run
- CentralReach
- Rethink
- AlohaABA
- WebABA
- Catalyst
Your biller works inside your system as a user you create. All the systems we work in.
Questions
Questions about ABA therapy billing
How are ABA authorizations measured?
Can a technician session and an analyst session be billed at the same time?
Who is the rendering provider on an ABA claim?
Can family guidance be delivered by telehealth?
What happens when units run out mid-month?
Should an ABA practice keep billing in-house or use a billing company?
What do you need from an ABA practice to start?
Next step
See where your ABA therapy claims are getting stuck.
Three quick questions. No patient data. A billing specialist reads every request and replies in writing.
- Three questions, about two minutes
- No patient data, no software to buy
- A written reply from a biller, not a sales deck
You answer three questions
A billing specialist reads them
A written reply by email
Prefer email? sales@remitwright.com
Request received
Thanks. Your review request is in.
Reference . Quote it if you write to us about this request.
- A billing specialist reads your answers and replies by email.
- If a look at real claims makes sense, we agree read-only access under a BAA first.
- You get a written summary of what is worth working and what it would take. No commitment.
While you wait: see the sample weekly report or read how switching works. You can also download the sample weekly report (PDF).