CPT 97154: Group Adaptive Behavior Treatment by Technician
Commercial payers pay $23 on average nationally for this procedure.
CPT code 97154 describes face-to-face group adaptive behavior treatment delivered by a technician under the supervision of a physician or other qualified healthcare professional, using an established protocol to address adaptive or maladaptive behaviors (for example, impaired social skills and communication); service type: behavioral/therapeutic intervention delivered in an outpatient or clinic setting, reported per 15 minutes of a technician providing care to two or more patients.
For related coverage guidance, see recent payer policy updates: Diagnosis of Idiopathic Environmental Intolerance, Allergen Testing, Allergen Testing.
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National Reimbursement Benchmarks
Commercial reimbursement for CPT 97154 centers around BUCA’s average commercial benchmark of $22.8, with notable variation among major payers. Blue Cross Blue Shield exhibits the highest dispersion (P75–P25 = $7.6), reflecting a wide spread of contracted rates, while Aetna and Cigna show tighter interquartile spreads of $1.8 and $7.7 respectively; UnitedHealth Group is moderate with a spread of $5.2. Blue Cross Blue Shield also posts the highest single maximum at $77.6, indicating outliers above most commercial averages.
Across national payers, average rates cluster from lower-single digits to the mid-$30s, with BUCA sitting near the center of that mix at $22.8. The relative IQRs highlight that Blue Cross Blue Shield contracts are the most variable and Aetna contracts the most consistent, with UnitedHealth Group and Cigna falling between those extremes.