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CPT 0373T: Adaptive Behavior Treatment with Protocol Modification

CPT code 0373T designates intensive adaptive behavior treatment provided by two or more technicians with protocol modifications for patients exhibiting severe destructive behaviors, billed in 15-minute increments of face-to-face technician time. This code captures services for complex behavioral interventions that require on-site physician or qualified professional direction and multiple staff members to manage safety and individualized protocol changes. Nationally, such services are critical for patients with severe self-injurious or other destructive behaviors and intersect clinical, regulatory, and billing considerations across payers.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for use of the code, where services are typically delivered, common billing relationships with related adaptive behavior codes, and the policy elements that affect coverage and reporting. The publication highlights how 0373T fits within the suite of adaptive behavior services, clarifies its time-based reporting convention, and outlines the typical scenarios that distinguish it from related codes such as assessment and single-technician protocol services. The content is intended for a national audience of clinicians, billing professionals, and policy analysts seeking clear, practical information about the code’s clinical application, payer landscape, and coding context.

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Billing Code Overview

CPT code 0373T describes adaptive behavior treatment with protocol modifications delivered by two or more technicians under the direction of an on–site physician or other qualified healthcare professional. The code is reported for each 15 minutes of face-to-face time that the technician(s) spend with a patient who requires modified protocols due to severe destructive behaviors, such as self-injurious behavior.

Service type: Intensive adaptive behavior treatment by multiple technicians with protocol modification

Typical site of service: On-site clinical or therapeutic setting where an on-site physician or qualified healthcare professional can direct technicians

National Reimbursement Benchmarks

National commercial rates for CPT 0373T cluster around BUCA’s average commercial benchmark of $31.8, with notable payer-specific differences. Blue Cross Blue Shield displays the highest dispersion (P75 $58.4 minus P25 $21.2 = $37.2), indicating wide variability in contracted rates; Cigna and Aetna show intermediate spread (Cigna P75 $40.9 minus P25 $4.9 = $36.0; Aetna P75 $21.0 minus P25 $3.0 = $18.0). UnitedHealth Group has a relatively tight spread (P75 $15.3 minus P25 $6.3 = $9.0), suggesting more consistent reimbursement levels.

Median and mean positions further differentiate payers: Blue Cross Blue Shield and Cigna have higher medians ($35.5 and $25.0, respectively) around or above BUCA’s average, while UnitedHealth Group and Aetna medians ($9.4 and $5.3) sit well below. This mix of high-center payers and tighter low-center payers implies varying negotiation landscapes across insurers for this code.

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CPT 0373T: Adaptive Behavior Treatment with Protocol Modification

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Billing Code Overview

Service type: Intensive adaptive behavior treatment by multiple technicians with protocol modification

Typical site of service: On-site clinical or therapeutic setting where an on-site physician or qualified healthcare professional can direct technicians

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 frequent severe self-injurious behaviors is referred for intensive applied behavior analysis (ABA). The child is seen in an outpatient behavioral health clinic that provides on-site physician or board-certified behavior analyst supervision. Two trained behavior technicians work together in 15-minute increments to implement an individualized adaptive behavior treatment plan with protocol modifications to safely manage and reduce destructive behaviors during direct, face-to-face therapy. The supervising clinician is present on-site to assess risk, authorize real-time protocol adjustments, and intervene if clinical escalation occurs. Sessions typically occur in an ambulatory behavioral health facility, specialized clinic space within a pediatric hospital, or home setting when the supervising professional is on-site and local payer rules permit.

Clinical workflow:

Referral and diagnostic confirmation by the supervising clinician, including review of prior assessments and medical history.
Development or update of a behavior intervention plan and protocol modifications by the supervising clinician based on functional assessment findings.
Two or more technicians deliver 0373T services in 15-minute face-to-face blocks, documenting target behaviors, antecedents, interventions used, and patient response.
On-site supervising clinician monitors sessions, provides immediate protocol changes as needed, documents supervisory involvement, and signs session notes per payer requirements.
Progress is reviewed periodically; billing aggregates the number of 15-minute units of 0373T provided during the encounter.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When billing only the supervising clinician's professional oversight is billed separate from facility or technician time.
`52`	Reduced services	When the planned session was partially delivered due to patient or clinical factors and services were reduced.
`53`	Discontinued procedure	When the session is terminated for an unforeseen clinical reason before therapeutic intent is met.
`62`	Two surgeons	When two qualified professionals of differing specialties jointly provide direct supervision requiring separate recognition (rare for this code; use only if payer allows).
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	When portions of supervision occur via real-time telemedicine and payer permits tele-supervision for the service.
`QX`	Modifier for services performed by a qualified health care professional under a specific arrangement (e.g., assistant)	When technicians work under a documented arrangement with delegated tasks and the payer requires this modifier to identify delegated services.
`QY`	Medical direction by a physician or other qualified health care professional for two, three, or four concurrent procedures	When a supervising clinician directs multiple concurrent technician teams per payer policy and the payer requires documentation of medical direction.
`CO`	Service provided as a result of a work-related injury/illness	When the adaptive behavior service is related to a workplace injury covered by workers' compensation.
`CQ`	Service performed under an alternative payment demonstration or pilot	When the encounter is part of a payer-authorized demonstration requiring this identifier.
`AF`	Service furnished in whole or part by a physical therapist assistant or occupational therapy assistant	If a payer requires specifying assistant personnel involvement relevant to billing staff mix (use per payer rules).
`FX`	Left side of the body	Uncommon for behavioral services; used only if a payer requires laterality for an associated physical intervention and is applicable.
`FY`	Right side of the body	As above for laterality when specifically required by payer rules.
`SH`	Speech–language pathology service provided under the direction of a physician or other qualified health care professional	When speech-related adaptive procedures are provided under supervision and payer requires this modifier.
`TD`	Diagnostic test or therapeutic service not completed due to patient reason	When the session was not completed because the patient refused or left prematurely.

Taxonomy Code	Specialty	Notes
`103T00000X`	Psychologist	Common supervising clinician for behavioral assessments and protocol modifications in ABA settings.
`1041C0700X`	Clinical Social Worker	Provides behavioral interventions and may supervise in some jurisdictions per payer rules.
`101YM0800X`	Mental Health Counselor	Delivers therapeutic interventions and may be part of the treatment team under supervision.
`2084P0800X`	Psychiatry & Neurology Physician	Medical oversight for complex cases, medication management, and high-risk behavior supervision.
`106H00000X`	Marriage & Family Therapist	Provides family-oriented behavioral guidance as part of the multidisciplinary team.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F84.0`	Autistic disorder	Core diagnosis commonly treated with adaptive behavior interventions; may present with severe destructive or self-injurious behaviors requiring multi-technician management.
`F84.5`	Asperger's syndrome	Developmental disorder on the autism spectrum; adaptive behavior treatment addresses social, communication, and behavior regulation deficits that can include challenging behaviors.
`F84.9`	Pervasive developmental disorder, unspecified	Used when a pervasive developmental disorder is present but specific subtype is not specified; may require individualized ABA with protocol adjustments for severe behaviors.
`F90.9`	Attention-deficit hyperactivity disorder, unspecified type	Comorbid condition that can exacerbate impulsive or disruptive behaviors; adaptive interventions target attentional and behavioral control strategies.
`F93.9`	Childhood emotional disorder, unspecified	Emotional and behavioral dysregulation in children that may manifest as destructive behaviors; adaptive behavior treatment focuses on skill building and behavior reduction.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97151`	Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician/qualified health care professional time face-to-face with patient and caregiver; initial assessment	Performed before `0373T` to identify target behaviors and develop the individualized intervention plan and measurable goals.
`97153`	Adaptive behavior treatment by protocol, administered by technician, face-to-face with one patient, each 15 minutes	Used for routine ABA services delivered by a single technician according to an established protocol; `0373T` is used instead when two or more technicians are required and protocol modifications are present for severe destructive behaviors.
`97155`	Adaptive behavior treatment with protocol modification, administered by a physician or other qualified health care professional, face-to-face with patient, each 15 minutes	Represents clinician-delivered adaptive behavior treatment with on-the-fly protocol modification; relates to `0373T` as supervisory and clinician-modified treatment components.
`97156`	Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without patient present), face-to-face with guardian/caregiver, each 15 minutes	Provides caregiver training and guidance that complements direct technician-delivered `0373T` sessions to generalize behavior support strategies.

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

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.

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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

Clinical workflow:

Referral and diagnostic confirmation by the supervising clinician, including review of prior assessments and medical history.
Development or update of a behavior intervention plan and protocol modifications by the supervising clinician based on functional assessment findings.
Two or more technicians deliver 0373T services in 15-minute face-to-face blocks, documenting target behaviors, antecedents, interventions used, and patient response.
On-site supervising clinician monitors sessions, provides immediate protocol changes as needed, documents supervisory involvement, and signs session notes per payer requirements.
Progress is reviewed periodically; billing aggregates the number of 15-minute units of 0373T provided during the encounter.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When billing only the supervising clinician's professional oversight is billed separate from facility or technician time.
`52`	Reduced services	When the planned session was partially delivered due to patient or clinical factors and services were reduced.
`53`	Discontinued procedure	When the session is terminated for an unforeseen clinical reason before therapeutic intent is met.
`62`	Two surgeons	When two qualified professionals of differing specialties jointly provide direct supervision requiring separate recognition (rare for this code; use only if payer allows).
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	When portions of supervision occur via real-time telemedicine and payer permits tele-supervision for the service.
`QX`	Modifier for services performed by a qualified health care professional under a specific arrangement (e.g., assistant)	When technicians work under a documented arrangement with delegated tasks and the payer requires this modifier to identify delegated services.
`QY`	Medical direction by a physician or other qualified health care professional for two, three, or four concurrent procedures	When a supervising clinician directs multiple concurrent technician teams per payer policy and the payer requires documentation of medical direction.
`CO`	Service provided as a result of a work-related injury/illness	When the adaptive behavior service is related to a workplace injury covered by workers' compensation.
`CQ`	Service performed under an alternative payment demonstration or pilot	When the encounter is part of a payer-authorized demonstration requiring this identifier.
`AF`	Service furnished in whole or part by a physical therapist assistant or occupational therapy assistant	If a payer requires specifying assistant personnel involvement relevant to billing staff mix (use per payer rules).
`FX`	Left side of the body	Uncommon for behavioral services; used only if a payer requires laterality for an associated physical intervention and is applicable.
`FY`	Right side of the body	As above for laterality when specifically required by payer rules.
`SH`	Speech–language pathology service provided under the direction of a physician or other qualified health care professional	When speech-related adaptive procedures are provided under supervision and payer requires this modifier.
`TD`	Diagnostic test or therapeutic service not completed due to patient reason	When the session was not completed because the patient refused or left prematurely.

Taxonomy Code	Specialty	Notes
`103T00000X`	Psychologist	Common supervising clinician for behavioral assessments and protocol modifications in ABA settings.
`1041C0700X`	Clinical Social Worker	Provides behavioral interventions and may supervise in some jurisdictions per payer rules.
`101YM0800X`	Mental Health Counselor	Delivers therapeutic interventions and may be part of the treatment team under supervision.
`2084P0800X`	Psychiatry & Neurology Physician	Medical oversight for complex cases, medication management, and high-risk behavior supervision.
`106H00000X`	Marriage & Family Therapist	Provides family-oriented behavioral guidance as part of the multidisciplinary team.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F84.0`	Autistic disorder	Core diagnosis commonly treated with adaptive behavior interventions; may present with severe destructive or self-injurious behaviors requiring multi-technician management.
`F84.5`	Asperger's syndrome	Developmental disorder on the autism spectrum; adaptive behavior treatment addresses social, communication, and behavior regulation deficits that can include challenging behaviors.
`F84.9`	Pervasive developmental disorder, unspecified	Used when a pervasive developmental disorder is present but specific subtype is not specified; may require individualized ABA with protocol adjustments for severe behaviors.
`F90.9`	Attention-deficit hyperactivity disorder, unspecified type	Comorbid condition that can exacerbate impulsive or disruptive behaviors; adaptive interventions target attentional and behavioral control strategies.
`F93.9`	Childhood emotional disorder, unspecified	Emotional and behavioral dysregulation in children that may manifest as destructive behaviors; adaptive behavior treatment focuses on skill building and behavior reduction.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97151`	Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician/qualified health care professional time face-to-face with patient and caregiver; initial assessment	Performed before `0373T` to identify target behaviors and develop the individualized intervention plan and measurable goals.
`97153`	Adaptive behavior treatment by protocol, administered by technician, face-to-face with one patient, each 15 minutes	Used for routine ABA services delivered by a single technician according to an established protocol; `0373T` is used instead when two or more technicians are required and protocol modifications are present for severe destructive behaviors.
`97155`	Adaptive behavior treatment with protocol modification, administered by a physician or other qualified health care professional, face-to-face with patient, each 15 minutes	Represents clinician-delivered adaptive behavior treatment with on-the-fly protocol modification; relates to `0373T` as supervisory and clinician-modified treatment components.
`97156`	Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without patient present), face-to-face with guardian/caregiver, each 15 minutes	Provides caregiver training and guidance that complements direct technician-delivered `0373T` sessions to generalize behavior support strategies.

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

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

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CPT 0373T: Adaptive Behavior Treatment with Protocol Modification

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Billing Code Overview

National Reimbursement Benchmarks

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OpenPayer

CPT 0373T: Adaptive Behavior Treatment with Protocol Modification

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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