Ensuring Procedural Integrity When Billing for Applied-Behavior-Analysis Services Using CPT Codes
Wayne W. Fisher, Ph.D., BCBA-D
MassABA is thrilled to offer a CPT code workshop with Dr. Wayne Fisher. Dr. Fisher worked with the AMA on behalf of Association for Behavior Analysis International (ABAI) in the development and acceptance of these codes. This training will focus on the use and interpretation of these codes that will go into effect January 1, 2019.
When: September 7, 2018, 9:00 AM-3:00 PM
Where: Sheraton Four Points Hotel, Norwood, MA
Cost: $135 per participant (includes lunch); space will be limited
There will be 5 Type-II Supervision CEUs available for BCBAs
Title: Ensuring Procedural Integrity when Billing for Applied-Behavior-Analysis Services using CPT codes.
Presenter: Wayne W. Fisher
Since 2009, ABAI has been working with the American Medical Association to establish new billing procedures for ABA and related services for children and youth with autism, as well as other conditions. In 2014, the AMA adopted Current Procedural Terminology (CPT) Category-III (or temporary) codes for ABA services. The AMA codes recognize that ABA services represent empirically supported and medically necessary interventions. Since 2015, ABAI has worked with APBA, Autism Speak, and the BACB to covert the temporary Category-III codes to permanent Category-I codes. In February 2017 the AMA CPT Editorial Panel accepted our code-change proposal to add eight new codes (mostly Category-I codes) and delete the fourteen existing Category-III codes effective January 1, 2019. In this workshop, I will explain the how the new codes define procedures and services performed by behavior analysts and how to bill for ABA services using these codes. Over time, the codes will result in systematic and standardized valuation of ABA services, and simplify and streamline the billing and collection processes for ABA services. Behavior analyst will need to learn to bill for ABA services using these new codes with high integrity in order to assure reliable and timely payment from third-party payers.
- Participants will be able to state the difference between the following types of billing codes: (a) Category-III CPT codes, (b) Category-I CPT Codes, and (c) h codes.
- Participants will be able state the three elements that contribute to the Resource-Based Relative Value Scale.
- Participants will be able to specify and apply the time rules for CPT codes.
- Participants will be able to specify the elements that should be included in a pre-authorization agreement between the insurance company and the service provider.
- Participants will be able state the three of most common reasons that insurance companies give for denying intensive behavioral treatment services.
- Participants will be able to identify at least two important points to make during a peer-to-peer review for pre-authorization of intensive behavioral treatment services.
Registration is closed for this event.