Summary & Overview
CPT 0367T: Adaptive Behavior Treatment (Deleted Code)
CPT code 0367T was designated for adaptive behavior treatment services, a critical component in behavioral health care aimed at enhancing functional skills and independence for patients with complex needs. The code's deletion marks a significant shift in how these services are documented and reimbursed, impacting providers and payers nationwide. Blue Cross Blue Shield and Cigna Health are among the major payers that previously covered services under this code, underscoring its broad relevance across commercial insurance markets.
This publication provides a comprehensive overview of the clinical context for 0367T, including its role in behavioral health, typical site of service, and its relationship to other deleted codes in the adaptive behavior analysis family. Readers will gain insight into recent policy updates, coding changes, and the implications for clinical documentation and billing practices. The summary also highlights associated taxonomies and relevant ICD-10 diagnoses, offering a clear picture of the patient populations and clinical specialties involved. Benchmarks and trends related to adaptive behavior treatment codes are discussed, equipping stakeholders with the information needed to navigate ongoing changes in behavioral health coding and reimbursement.
CPT Code Overview
CPT code 0367T represents an adaptive behavior treatment service within the behavioral health category. This code was previously used to report specialized interventions aimed at improving adaptive functioning for individuals with behavioral health needs. The typical site of service for procedures billed under 0367T is an ambulatory surgical center, designated as Place of Service 24. This code has been deleted and is no longer active for billing, reflecting changes in clinical practice and coding standards for adaptive behavior treatments.
Clinical & Coding Specifications
Clinical Context
A patient presents to an ambulatory surgical center with visual impairment due to age-related eye conditions such as cataracts or macular degeneration. The provider, who may be an ophthalmologist, glaucoma specialist, or retina specialist, evaluates the patient and determines that adaptive behavior treatment is appropriate to help the patient adjust to vision loss and improve daily functioning. The clinical workflow involves assessment, planning, and implementation of adaptive strategies tailored to the patient's needs, often as part of a multidisciplinary approach in behavioral health. The procedure is performed in an outpatient setting, focusing on enhancing the patient's ability to cope with and adapt to their visual limitations.
Coding Specifications
| Modifier Code | Description | Usage Context |
|---|---|---|
51 | Multiple Procedures | Used when more than one procedure is performed during the same session. |
RT | Right Side | Indicates the procedure was performed on the right side of the body. |
LT |