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Tuesday, November 13, 2018

Insurance Billing Codes

The Politics of Autism includes an extensive discussion of insurance.

From Autism Speaks:
New CPT codes for ABA billing have been announced by the American Medical Association CPT Editorial Panel. These codes will take effect on January 1, 2019.
Autism Speaks has worked for multiple years on the CPT Steering Committee seeking AMA approval of these new codes. We are happy to join the committee in helping you understand and implement the new CPT codes for ABA services.

What are CPT codes?
Current Procedural Terminology (CPT) is a listing of terms and identifying codes used to report medical services and to bill insurance providers. CPT codes are issued and maintained by the American Medical Association (AMA).
CPT codes are classified either as Category I (permanent) or Category III (temporary).

How have the CPT codes changed?
ABA codes were first approved in 2013 and fell under Category III (temporary).
A workgroup was formed shortly after in order to revise the code set. The CPT Steering Committee included Autism Speaks, the Association for Behavior Analysis International, the Association of Professional Behavior Analysts, and the Behavior Analyst Certification Board.
            In the fall of 2018, the new codes for ABA billing were announced with important changes:
Eight new Category I CPT (permanent) codes for ABA services were approved.
Two Category III (temporary) codes were revised.
Blythe Bernhard at Disability Scoop:
“We expect that it will expand the types of services that insurance companies reimburse for,” said Wayne Fisher, director of the Center for Autism Spectrum Disorders at the University of Nebraska Medical Center and a member of the steering committee made up of representatives from various autism organizations that worked on the coding changes.
With the move, the medical association will recognize ABA as medically necessary under appropriate circumstances, Fisher said.