CPT 0362T: Behavior Identification Supporting Assessment, On-site

Commercial payers pay $83 on average nationally for this procedure.

CPT code 0362T describes an on-site behavior identification supporting assessment in which a physician or other qualified healthcare professional directs technicians to perform follow-up assessment of a patient’s maladaptive destructive behavior; the service is reported in 15-minute units of face-to-face technician time and includes the provider’s direction, interpretation, and report. This service is a procedural assessment typically delivered in an appropriate on-site clinical or therapeutic environment such as an outpatient behavioral health clinic, specialty therapy center, or other supervised treatment setting and is classified as a time-based, face-to-face assessment service for behavioral health.

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.

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.

National Payer Mean Reimbursement Rates

State Reimbursement Rates

State: Alaska1 / 51

Rate by payer

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., adaptive behavior treatment sessions) are scheduled as needed.

Related Modifiers

7 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
95	Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…	- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
23	Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…	- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
51	Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…	- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…

Related Provider Taxonomies

8 rows

Taxonomy Code
103T00000X
1041C0700X
101YM0800X
204F00000X
2278P1005X
163W00000X
374K00000X
246ZX2200X

Related ICD-10-CM Codes

32 rows

ICD-10-CM Code	Description
F32.9	Major depressive disorder, single episode, unspecified
F33.1	Major depressive disorder, recurrent, moderate
F34.1	Dysthymic disorder
F41.1	Generalized anxiety disorder
F41.9	Anxiety disorder, unspecified
F43.10	Post-traumatic stress disorder, unspecified
F43.21	Adjustment disorder with depressed mood
F50.9	Eating disorder, unspecified
F84.0	Autistic disorder
F84.5	Asperger's syndrome

Showing 1–10 of 32

Related Payer Policy Updates

Specialty: Neurology/Neurosurgery1 / 3

10 rows

Policy	Payer	Effective Date
Clinical Review Criteria Intraoperative Neurophysiological Monitoring (IONM)	Kaiser Permanente	2027-01-01
Remote Electrical Neuromodulation for Migraines (i.e., Nerivio®)	bcbsvermont	2026-11-01
Lumbar Microdiscectomy	univerahealthcare	2026-10-15
Artificial Cervical Intervertebral Disc	univerahealthcare	2026-10-15
Lumbar Decompression	univerahealthcare	2026-10-15
Responsive Neurostimulation for Focal Epilepsy	Premera Bluecross	2026-10-14
Intraoperative Monitoring	Providence Health Plan	2026-10-01
Intraoperative Monitoring	Providence Health Plan	2026-10-01
High-Intensity Focused Ultrasound	Mass General Brigham Health Plan	2026-10-01
Vagal Nerve Stimulation	Ambetter Nevada	2026-10-01

CPT 0373T: Adaptive Behavior Treatment with Protocol Modifications

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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.

Explore openpayer tools

View all tools

State Reimbursement Rates

State: Alaska1 / 51

Rate by payer

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., adaptive behavior treatment sessions) are scheduled as needed.

Related Modifiers

7 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
95	Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…	- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
23	Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…	- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
51	Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…	- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…

Related Provider Taxonomies

8 rows

Taxonomy Code
103T00000X
1041C0700X
101YM0800X
204F00000X
2278P1005X
163W00000X
374K00000X
246ZX2200X

Related ICD-10-CM Codes

32 rows

ICD-10-CM Code	Description
F32.9	Major depressive disorder, single episode, unspecified
F33.1	Major depressive disorder, recurrent, moderate
F34.1	Dysthymic disorder
F41.1	Generalized anxiety disorder
F41.9	Anxiety disorder, unspecified
F43.10	Post-traumatic stress disorder, unspecified
F43.21	Adjustment disorder with depressed mood
F50.9	Eating disorder, unspecified
F84.0	Autistic disorder
F84.5	Asperger's syndrome

Showing 1–10 of 32

Related Payer Policy Updates

Specialty: Neurology/Neurosurgery1 / 3

10 rows

Policy	Payer	Effective Date
Clinical Review Criteria Intraoperative Neurophysiological Monitoring (IONM)	Kaiser Permanente	2027-01-01
Remote Electrical Neuromodulation for Migraines (i.e., Nerivio®)	bcbsvermont	2026-11-01
Lumbar Microdiscectomy	univerahealthcare	2026-10-15
Artificial Cervical Intervertebral Disc	univerahealthcare	2026-10-15
Lumbar Decompression	univerahealthcare	2026-10-15
Responsive Neurostimulation for Focal Epilepsy	Premera Bluecross	2026-10-14
Intraoperative Monitoring	Providence Health Plan	2026-10-01
Intraoperative Monitoring	Providence Health Plan	2026-10-01
High-Intensity Focused Ultrasound	Mass General Brigham Health Plan	2026-10-01
Vagal Nerve Stimulation	Ambetter Nevada	2026-10-01

CPT 0373T: Adaptive Behavior Treatment with Protocol Modifications

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

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

97152

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 0362T: Behavior Identification Supporting Assessment, On-site

Sign up for cpt 0362T policy alerts

National Reimbursement Benchmarks

CPT 0362T: Behavior Identification Supporting Assessment, On-site

Sign up for cpt 0362T policy alerts

National Reimbursement Benchmarks

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

References

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

References

Related CPT Codes

CPT 0362T: Behavior Identification Supporting Assessment, On-site

Sign up for cpt 0362T policy alerts

National Reimbursement Benchmarks

CPT 0362T: Behavior Identification Supporting Assessment, On-site

Sign up for cpt 0362T policy alerts

National Reimbursement Benchmarks

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

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

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

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

Related CPT Codes