Find policies, billing codes, payers, states, and providers

CPT 0362T: Follow-Up Assessment of Maladaptive Destructive Behavior

CPT code 0362T represents an on-site follow-up assessment of maladaptive destructive behavior performed by a physician or other qualified healthcare professional with the assistance of one or more technicians, reported in 15-minute units. This code captures the provider’s direction, interpretation, and report tied to technician face-to-face time and is relevant where structured behavioral reassessment is part of clinical care for children and adolescents with disruptive or developmental disorders. Nationally, the code matters for behavioral health service documentation, time-based billing, and alignment between qualified professionals and technician-delivered services.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for use of the code, common billing relationships with related treatment codes, and the typical settings where the service is provided. The publication summarizes billing structure, common use cases tied to behavioral disorders in pediatric and adolescent populations, and how the code interfaces with technician-delivered care models.

This summary is intended for a national audience of clinicians, coding specialists, and payers seeking clear, actionable information on the clinical purpose and billing mechanics of CPT code 0362T.

Customize your policy alerts

Sign up for cpt 0362T policy alerts

Get alerted when payer policies referencing 0362T are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

CPT code 0362T describes an on-site follow-up assessment of a patient’s maladaptive destructive behavior performed by a physician or other qualified healthcare professional with one or more technicians. The code is reported for each 15 minutes of face-to-face time that the technician(s) spend with the patient and includes the provider’s direction, interpretation, and report.

Service type: Behavioral follow-up assessment with technician support

Typical site of service: On-site clinical setting appropriate for behavioral assessment, such as outpatient behavioral health clinics or specialized assessment centers.

National Reimbursement Benchmarks

National commercial reimbursement for CPT 0362T centers on BUCA’s average commercial benchmark of $83, which serves as a mid-market reference point among the payers. Blue Cross Blue Shield’s distribution is relatively broad (P75–P25 = $93.2 - $40.6 = $52.6), while UnitedHealth Group exhibits the widest dispersion (P75–P25 = $242.6 - $109.3 = $133.3), indicating substantial variability in contracted rates. Aetna and Cigna have tighter spreads by comparison (Aetna: $68.7 - $13.0 = $55.7; Cigna: $88.2 - $40.5 = $47.7), though Aetna’s low median pulls its center lower than BUCA.

Median positioning also differs: Blue Cross Blue Shield and UnitedHealth Group sit well above BUCA’s $83 average (BCBS median $57.3; UnitedHealth Group median $155.5), with UnitedHealth Group’s high mean ($174.1) reflecting high-end outliers. Cigna (median $51) and Aetna (median $18) are below BUCA on central tendency, highlighting payer-by-payer variation in customary commercial payments for this code.

Find policies, billing codes, payers, states, and providers

CPT 0362T: Follow-Up Assessment of Maladaptive Destructive Behavior

This summary is intended for a national audience of clinicians, coding specialists, and payers seeking clear, actionable information on the clinical purpose and billing mechanics of CPT code 0362T.

Customize your policy alerts

Sign up for cpt 0362T policy alerts

Get alerted when payer policies referencing 0362T are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

Service type: Behavioral follow-up assessment with technician support

Typical site of service: On-site clinical setting appropriate for behavioral assessment, such as outpatient behavioral health clinics or specialized assessment centers.

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 9-year-old child with a diagnosis of F84.0 (Autistic disorder) and co-occurring F90.9 (Attention-deficit hyperactivity disorder, unspecified type) is referred for a follow‑up adaptive behavior identification assessment after an initial behavior plan was implemented at school. The child demonstrates maladaptive destructive behaviors (e.g., property destruction, self-directed hitting) that interfere with learning and safety. An on-site psychologist directs two trained behavior technician assistants who conduct structured, face‑to‑face observations and behavior‑elicitation tasks in a school or clinic classroom setting while the supervising clinician remains present to interpret findings and finalize the report.

Workflow:

Referral and scheduling: School special education team or pediatrician requests follow‑up assessment; appointment scheduled in an appropriate environment (school classroom or outpatient behavioral health clinic).
Pre-visit preparation: Clinician reviews prior assessment, behavior plan, and recent incident reports; consent and authorization confirmed.
On‑site assessment session: Technician(s) spend discrete 15‑minute blocks performing direct, face‑to‑face behavior observation, structured probes, and data collection while the on‑site clinician supervises, provides direction, and documents procedure. Each 15 minutes of technician face‑to‑face time is reported with 0362T.
Interpretation and reporting: The clinician interprets technician-collected data, integrates with clinical history, adjusts recommendations for behavior intervention, and produces a written report for the referring team.
Communication and follow‑up: Findings and revised behavior supports are communicated to caregivers, school staff, and treatment team; follow‑up plan and subsequent services (e.g., 97152 adaptive behavior treatment sessions) are scheduled as needed.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When billing only the clinician’s interpretive/supervisory component separate from technician services (rare for `0362T`).
`52`	Reduced services	When the session is partially completed or abbreviated relative to typical performance.
`53`	Discontinued procedure	When the assessment session is started but halted for patient safety or other justified reason.
`59` not provided in input	Data not available in the input.
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	If portions of supervision or interpretation occur via telehealth while technicians remain on-site.
`QX`	Qualified non‑physician health care professional‑with QHP assistant	When a qualified health professional assistants model is used per payer rules (use only if supported by payer).
`QY`	Attending‑supervising provider when required by program	When documentation mandates a supervising qualified provider on site or immediately available.
`SH`	Medicare‑certified speech‑language pathologist service	Use only if a speech‑language pathology taxonomy and role apply to the supervised technicians during communication‑focused observations.
`SJ`	Non‑physician practitioner assistant at service	When a non‑physician practitioner assistant participates under applicable state/payer rules.
`22`	Unusual procedural services — increased procedural services	When documentation supports substantially greater effort, time, or complexity beyond typical for `0362T`.
`23`	Unusual anesthesia — when procedures are performed under general anesthesia	Not typically applicable but included when anesthesia environment affected assessment workflow.
`51`	Multiple procedures	If billing multiple distinct procedures in the same session and payers require modifier for multiple services.
`52`	Reduced services	Duplicate entry above; use once where appropriate.

Taxonomy Code	Specialty	Notes
`103T00000X`	Psychologist	Frequently supervises behavior technicians and provides interpretation and reporting for adaptive behavior assessments.
`1041C0700X`	Clinical Social Worker	May perform supervision and clinical interpretation for behavior assessments in community and school settings.
`101YM0800X`	Mental Health Counselor	May direct technician work and integrate assessment findings into treatment planning.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F91.9`	Conduct disorder, unspecified	Maladaptive externalizing behaviors such as aggression and property destruction that are targets for behavior identification and intervention.
`F84.0`	Autistic disorder	Social communication deficits and repetitive or maladaptive behaviors often require adaptive behavior assessment to inform individualized behavior supports.
`F90.9`	Attention-deficit hyperactivity disorder, unspecified type	Impulsivity and hyperactivity that can contribute to maladaptive destructive behaviors addressed during assessment and treatment planning.
`F93.9`	Childhood emotional disorder, unspecified	Emotional dysregulation impacting behavior; assessment helps distinguish function and guide supports.
`F98.9`	Unspecified behavioral and emotional disorders with onset usually occurring in childhood and adolescence	Includes diverse behavior presentations where structured behavior identification assessment informs intervention strategy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`0362T`	Adaptive behavior identification supporting assessment, on‑site physician or other qualified healthcare professional with technician(s), each 15 minutes of face‑to‑face time (behavior identification supporting assessment)	Primary code for each 15 minutes that technician(s) spend face‑to‑face with the patient under on‑site clinician direction; includes clinician direction, interpretation, and report.
`97152`	Adaptive behavior treatment, administered by technician under direction of qualified health care professional, face‑to‑face, each 15 minutes	Common follow‑on service delivering behavior intervention based on findings from the `0362T` assessment; billed per 15‑minute technician treatment blocks.

CPT 0373T: Adaptive Behavior Treatment with Protocol Modification

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Workflow:

Referral and scheduling: School special education team or pediatrician requests follow‑up assessment; appointment scheduled in an appropriate environment (school classroom or outpatient behavioral health clinic).
Pre-visit preparation: Clinician reviews prior assessment, behavior plan, and recent incident reports; consent and authorization confirmed.
On‑site assessment session: Technician(s) spend discrete 15‑minute blocks performing direct, face‑to‑face behavior observation, structured probes, and data collection while the on‑site clinician supervises, provides direction, and documents procedure. Each 15 minutes of technician face‑to‑face time is reported with 0362T.
Interpretation and reporting: The clinician interprets technician-collected data, integrates with clinical history, adjusts recommendations for behavior intervention, and produces a written report for the referring team.
Communication and follow‑up: Findings and revised behavior supports are communicated to caregivers, school staff, and treatment team; follow‑up plan and subsequent services (e.g., 97152 adaptive behavior treatment sessions) are scheduled as needed.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When billing only the clinician’s interpretive/supervisory component separate from technician services (rare for `0362T`).
`52`	Reduced services	When the session is partially completed or abbreviated relative to typical performance.
`53`	Discontinued procedure	When the assessment session is started but halted for patient safety or other justified reason.
`59` not provided in input	Data not available in the input.
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	If portions of supervision or interpretation occur via telehealth while technicians remain on-site.
`QX`	Qualified non‑physician health care professional‑with QHP assistant	When a qualified health professional assistants model is used per payer rules (use only if supported by payer).
`QY`	Attending‑supervising provider when required by program	When documentation mandates a supervising qualified provider on site or immediately available.
`SH`	Medicare‑certified speech‑language pathologist service	Use only if a speech‑language pathology taxonomy and role apply to the supervised technicians during communication‑focused observations.
`SJ`	Non‑physician practitioner assistant at service	When a non‑physician practitioner assistant participates under applicable state/payer rules.
`22`	Unusual procedural services — increased procedural services	When documentation supports substantially greater effort, time, or complexity beyond typical for `0362T`.
`23`	Unusual anesthesia — when procedures are performed under general anesthesia	Not typically applicable but included when anesthesia environment affected assessment workflow.
`51`	Multiple procedures	If billing multiple distinct procedures in the same session and payers require modifier for multiple services.
`52`	Reduced services	Duplicate entry above; use once where appropriate.

Taxonomy Code	Specialty	Notes
`103T00000X`	Psychologist	Frequently supervises behavior technicians and provides interpretation and reporting for adaptive behavior assessments.
`1041C0700X`	Clinical Social Worker	May perform supervision and clinical interpretation for behavior assessments in community and school settings.
`101YM0800X`	Mental Health Counselor	May direct technician work and integrate assessment findings into treatment planning.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F91.9`	Conduct disorder, unspecified	Maladaptive externalizing behaviors such as aggression and property destruction that are targets for behavior identification and intervention.
`F84.0`	Autistic disorder	Social communication deficits and repetitive or maladaptive behaviors often require adaptive behavior assessment to inform individualized behavior supports.
`F90.9`	Attention-deficit hyperactivity disorder, unspecified type	Impulsivity and hyperactivity that can contribute to maladaptive destructive behaviors addressed during assessment and treatment planning.
`F93.9`	Childhood emotional disorder, unspecified	Emotional dysregulation impacting behavior; assessment helps distinguish function and guide supports.
`F98.9`	Unspecified behavioral and emotional disorders with onset usually occurring in childhood and adolescence	Includes diverse behavior presentations where structured behavior identification assessment informs intervention strategy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`0362T`	Adaptive behavior identification supporting assessment, on‑site physician or other qualified healthcare professional with technician(s), each 15 minutes of face‑to‑face time (behavior identification supporting assessment)	Primary code for each 15 minutes that technician(s) spend face‑to‑face with the patient under on‑site clinician direction; includes clinician direction, interpretation, and report.
`97152`	Adaptive behavior treatment, administered by technician under direction of qualified health care professional, face‑to‑face, each 15 minutes	Common follow‑on service delivering behavior intervention based on findings from the `0362T` assessment; billed per 15‑minute technician treatment blocks.

CPT 0373T: Adaptive Behavior Treatment with Protocol Modification

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 0362T: Follow-Up Assessment of Maladaptive Destructive Behavior

Sign up for cpt 0362T policy alerts

Billing Code Overview

National Reimbursement Benchmarks

Catch payer policy changes before they impact reimbursement

Catch payer policy changes before they impact reimbursement

OpenPayer

CPT 0362T: Follow-Up Assessment of Maladaptive Destructive Behavior

Sign up for cpt 0362T policy alerts

Billing Code Overview

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 0362T: Follow-Up Assessment of Maladaptive Destructive Behavior

Sign up for cpt 0362T policy alerts

Billing Code Overview

National Reimbursement Benchmarks

CPT 0362T: Follow-Up Assessment of Maladaptive Destructive Behavior

Sign up for cpt 0362T policy alerts

Billing Code Overview

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 0362T specifically represent and when is it used?

Where and how is the 0362T service typically provided?

Which modifiers are applicable to 0362T and when might they be used?

What do the reimbursement benchmarks indicate about payer variation for CPT 0362T?

Which related CPT codes and diagnoses are commonly associated with use of 0362T?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 0362T specifically represent and when is it used?

Where and how is the 0362T service typically provided?

Which modifiers are applicable to 0362T and when might they be used?

What do the reimbursement benchmarks indicate about payer variation for CPT 0362T?

Which related CPT codes and diagnoses are commonly associated with use of 0362T?

References