Model Health Insurance Coverage Policy for Adaptive Behavior Services: An Introduction for Providers
Presented by the ABA Coding Coalition
Sept. 17, 2020, 2:00-4:00 PM EDT
James E. Carr, PhD, BCBA-D, Behavior Analyst Certification Board
Gina Green, PhD, BCBA-D, Association of Professional Behavior Analysts
Jenna Minton, JD, Proactive Strategies LLC
Lorri Unumb, JD, Council of Autism Service Providers
After the American Medical Association’s CPT Editorial Panel issues CPT codes for a healthcare service or set of services, it is common for one or more specialty societies to develop a model coverage policy to foster appropriate, consistent coverage of the services by health plans. The ABA Coding Coalition (representatives of the Association of Professional Behavior Analysts, Autism Speaks, Behavior Analyst Certification Board, Council of Autism Service Providers, and their CPT consultant) has developed a model coverage policy for adaptive behavior (applied behavior analysis; ABA) assessment and treatment services.
The Coalition comprises most of the individuals and organizations who authored the application that was submitted to the AMA CPT Editorial Panel in 2016 to obtain the Category I and modified Category III CPT codes for those services. The new and modified codes went into effect in 2019. In this webinar, members of the Coalition will preview the model coverage policy for providers. Indications, limitations, billing codes, provider qualifications, and documentation requirements for adaptive behavior services will be highlighted and described briefly. Participants will have an opportunity to ask questions, and will receive a copy of the model coverage policy.
CASP Members: Free