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.
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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.