CPT 0363T: Adaptive Behavior Treatment by Technician, Face-to-Face
Commercial payers pay $36 on average nationally for this procedure.
CPT code 0363T was a deleted code (effective January 1, 2019) that represented adaptive behavior treatment by protocol administered by a technician in a face-to-face setting; the service type is behavioral intervention for autism spectrum and related developmental disorders, typically delivered in outpatient clinics, home, or community settings.
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National Reimbursement Benchmarks
National commercial reimbursement for CPT 0363T clusters around the low $40s, with BUCA’s average commercial rate at $36.4 forming the baseline for an average commercial payer. Cigna’s distribution centers near a $39.4 median and spans from a $31.8 first quartile to a $40 third quartile, giving it a relatively compact spread; the interquartile range (P75−P25) is $8.2 for Cigna and $6.2 for BUCA.
Comparing dispersion across payers, Cigna exhibits the tightest interquartile band at $8.2, indicating less variability among commercial contracts than BUCA’s $6.2 IQR, though BUCA’s mean and quartiles lie slightly lower overall. Max and min values available for Cigna also show its upper bound reaches $40, aligning with the high end of the commercial range.