rethink-vbmapp-promo Category 1 CPT Codes

Anthony Porcelli, Manager of Billing Services for Rethink Behavioral Health, had the pleasure of attending Dr. Wayne Fisher’s workshop on the new Category 1 CPT Codes for ABA Services, which will be effective January 1, 2019.

I split the workshop into 3 sections:

  1. Interpreting the new Category 1 CPT Codes
  2. Suggestions to help valuate the codes when negotiating rates with payers
  3. The work was undertaken to get the new Category 1 CPT Codes accepted by the American Medical Association (AMA)

The two great advantages I see with the new codes are that they are broken up into 15-minute units to allow for more efficient billing and the ongoing codes are no longer needed.

A quick crosswalk for the more commonly used codes is listed below and more detailed descriptions can be found here.

Old Category 3 CodeNew Category 1 Code
0359T97151
0360T – 0361T97152
0364T – 0365T97153
0368T – 0369T97155
0370T97156
0371T97157

A key talking point of the workshop involved valuating the codes when negotiating rates with payers.

When negotiating rates it is important to demonstrate to payers the amount of work that goes into each service.

For instance, when negotiating rates for a technician appointment (0364T – 0365T) providers should mention the training that is involved between the BCBA and the tech before the appointment, the work that goes on during the actual appointment, and the interpretation of data and session notes created afterward.

To do this, Dr. Fisher suggested that providers consider each CPT Code in 3 parts:

  • Pre-Service
  • Intra-Service
  • Post-Service

Pre-Service includes everything that goes on before the appointment takes place such as training staff and writing protocols.

Intra-Service consists of the work that goes on during the actual appointment itself while Post-Service is the work that happens after a session is completed such as writing progress notes and reviewing data.

By doing this, the provider can adequately describe the full scope of work that goes into each appointment.

A further example is provided below for what goes into a Support/Technician Appointment:

0364T – 0365T

Pre-Service Work

  1. BCBA: Trains a technician to perform the service.
  2. RBT: Attends trainings with BCBA. Reviews patient medical records. Creates materials for sessions.

Intra-Service Work

  1. RBT: Works with client based on protocols created by BCBA.

Post-Service

  1. RBT: Writes session notes. Communicates with BCBA as needed about sessionw.
  2. BCBA: Reviews/Approves session notes. Interprets data. Updates treatment plan.

Next Steps

The last piece of the workshop involved discussion on the next steps that Dr. Fisher and his group would be working on involving the new Category 1 CPT Codes.

The first order of business for the group is releasing a “Tool Kit” for providers to help valuate their services when getting ready to negotiate with payers.

Dr. Fisher and his team will also be working with the AMA to address the issue of billing for both the RBT and BCBA during overlapping service times.

He believes providers should be able to bill for both services concurrently due to the fact that the responsibilities of each professional during the mutual session are different.

In Summary

In summation, I believe the new codes will positively affect the ABA world and simplify the billing process.

Since the ongoing codes have been eliminated, there will be less line errors during billing, leading to faster payments and less back-and-forth interaction with the insurance companies so that providers can spend more time with their clients.

Also, since the new codes have been assigned category 1 status, I am hoping that payers will be more uniform with their interpretations of their use which will also make for improved efficiency in billing.

rethink-promo- Category 1 CPT Codes

From scheduling the appointment to providing resources for treatment and tracking progress to getting paid – Rethink Behavioral Health will completely support you.

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  • Billing & Full Revenue Cycle Management (RCM) features electronic claims submission & remittances, eligibility verification, patient statements and payments portal, financial reporting, and more!
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