Model Health Insurance Coverage Policy for Adaptive Behavior Services
An Introduction for Providers
Original Webinar Date: September 17, 2020
CEU offered: 2.0 Learning CEU
Short Title: MCP for Adaptive Behavior Services
Webinar Duration: 2 hour
- Gina Green, Ph.D., BCBA-D
- Jim Carr, Ph.D., BCBA-D
- Jenna Minton, Esq
- Lorri Unumb, Esq
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.