Direct Therapy
The definition of this code is: adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes
What is 97153
The definition of this code is: group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with two or more patients, each 15 minutes
What is 97154
The definition of this code is: adaptive behavior treatment with protocol modification administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes
What is 97155
The definition of this code is: 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
What is 97156
The definition of this code is: 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 and/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
What is 97151
The definition of this code is: adaptive behavior treatment with protocol modification, each 15 minutes of technicians' time face-to-face with a patient, requiring the following components: administered by the physician or other qualified health care professional who is on site, with the assistance of two or more technicians, for a patient who exhibits destructive behavior, and completed in an environment that is customized to the patient's behavior.
What is 0373T
The definition of this code is: group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional face-to-face with multiple patients, each 15 minutes
What is 97158
Maximum number of units/day allowed to be delivered of 97155 based on national guidance
What is 24
The definition of this code is: multiple-family group adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of guardians/caregivers, each 15 minutes
What is 97157
The definition of this code is: behavior identification supporting assessment, administered by one technician under the direction of a physician or other qualified health care professional, face-to-face with the patient, each 15 minutes
What is 97152
National daily MUE for 97153
What is 32 units or 8 hours
The largest number of patients allowed in group treatment
What is 8
In the context of 97155, this term refers to the QHP directly monitoring the delivery of treatment to a patient by a behavior technician. The focus is on ensuring that treatment protocols are implemented correctly.
What is "direction"
The family guidance code(s) that can be reported while the patient is in direct therapy, either group or 1:1
What is 97156 and 97157
The definition of this code is: behavior identification supporting assessment, each 15 minutes of technicians' time face-to-face with a patient, requiring the following components: administered by the physician or other qualified health care professional who is on site, with the assistance of two or more technicians, for a patient who exhibits destructive behavior, and completed in an environment that is customized to the patient's behavior.
What is 0362T
This direct therapy code cannot be billed concurrently with 97155, based on national guidance
What is 0373T
This group therapy code can be reported concurrently with 97155
What is 97154
This term refers to processes through which the QHP ensures that the supervisee practices in a competent, professional, and ethical manner in accordance with the standards of the profession
What is "supervision"
The number of family guidance hours reported when 97157 is delivered to 8 caregivers of 4 patients for one hour
What is 4 hours
The only code that allows for non-face-to-face time performing specific activities to be billable
What is 97151
This encompasses a written description of procedures for implementing a specified service to address a patient's assessment or treatment goal(s) and implementation of the procedures with the patient.
What is an adaptive-behavior service protocol
The maximum number of units or hours that can be delivered of 97154 daily based on the national MUE
What is 18 units or 4.5 hours
This person is not required to be present during time that 97155 is being delivered by the QHP
What is the technician or supervisee
The family guidance code(s) that has a national MUE of 16 units/day
What is 97156 and 97157
The maximum number of units or hours allowed to be billed daily for 97151 based on the national MUEs
What is 8 units or 2 hours