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    v1.0.30
    OpenPayerBilling CodesAdaptive Behavior AssessmentsCPT cpt-0373t-adaptive-behavior-treatment-multi-tech-severe-behavior
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    CPT 0373T: Adaptive Behavior Treatment with Protocol Modifications

    Commercial payers pay $32 on average nationally for this procedure.

    CPT code 0373T describes face-to-face adaptive behavior treatment with protocol modifications provided by two or more technicians under the direction of an on-site physician or qualified healthcare professional for patients with severe destructive behaviors; billing is per 15 minutes of technician time and the service is typically delivered in an ambulatory clinic or intensive outpatient/behavioral treatment setting as a team-based behavioral intervention.

    For related coverage guidance, see recent payer policy updates: Clinical Review Criteria Intraoperative Neurophysiological Monitoring (IONM), Remote Electrical Neuromodulation for Migraines (i.e., Nerivio®), Lumbar Microdiscectomy.

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    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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    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 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.

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    26Modifier 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…
    52Modifier ‑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…
    53Modifier 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…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    95Modifier 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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    103T00000X
    1041C0700X
    101YM0800X
    2084P0800X
    106H00000X
    286500000X
    207QG0300X
    175M00000X

    Related Payer Policy Updates

    Specialty: Neurology/Neurosurgery1 / 3

    10 rows

    PolicyPayerEffective Date
    Clinical Review Criteria Intraoperative Neurophysiological Monitoring (IONM)Kaiser Permanente2027-01-01
    Remote Electrical Neuromodulation for Migraines (i.e., Nerivio®)bcbsvermont2026-11-01
    Lumbar Microdiscectomyuniverahealthcare2026-10-15
    Artificial Cervical Intervertebral Discuniverahealthcare2026-10-15
    Lumbar Decompressionuniverahealthcare2026-10-15
    Responsive Neurostimulation for Focal EpilepsyPremera Bluecross2026-10-14
    Intraoperative MonitoringProvidence Health Plan2026-10-01
    Intraoperative MonitoringProvidence Health Plan2026-10-01
    High-Intensity Focused UltrasoundMass General Brigham Health Plan2026-10-01
    Vagal Nerve StimulationAmbetter Nevada2026-10-01

    Related Codes

    CPT-0362T-BEHAVIORAL-FOLLOW-UP-ASSESSMENT-TECHNICIAN-15MIN

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

    Frequently Asked Questions

    References

    1. 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. 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. 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.
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    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.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    97151Behavior 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 assessmentPerformed before 0373T to identify target behaviors and develop the individualized intervention plan and measurable goals.
    97153Adaptive behavior treatment by protocol, administered by technician, face-to-face with one patient, each 15 minutesUsed 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.
    97155Adaptive behavior treatment with protocol modification, administered by a physician or other qualified health care professional, face-to-face with patient, each 15 minutesRepresents clinician-delivered adaptive behavior treatment with on-the-fly protocol modification; relates to 0373T as supervisory and clinician-modified treatment components.
    97156Family 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 minutesProvides caregiver training and guidance that complements direct technician-delivered 0373T sessions to generalize behavior support strategies.