CPT 97155: Adaptive Behavior Treatment by QHP, Face-to-Face
Commercial payers pay $66 on average nationally for this procedure.
CPT code 97155 describes adaptive behavior treatment delivered face-to-face by a physician or other qualified healthcare professional who provides and modifies protocol targets and treatment techniques while simultaneously teaching a technician; the service is reported in 15-minute units and is typically provided in outpatient or clinic behavioral health settings during direct patient care encounters.
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
The national commercial landscape for CPT 97155 centers around BUCA’s average commercial benchmark of $66.10, serving as a mid-market reference. Blue Cross Blue Shield (BCBS) and UnitedHealth Group sit above BUCA on averages at $90.60 and $41.80 respectively, while Cigna ($34.00) and Aetna ($24.50) trend lower. Cigna’s maximum of $69.60 and BCBS’s maximum of $221.40 illustrate pockets of high reimbursement but those maxima are not representative of central tendency across payers.
Dispersion measured by the interquartile range (P75–P25) highlights where rates are most and least consistent. Blue Cross Blue Shield shows the widest IQR of $17.40 ($97.30−$79.90), followed by UnitedHealth Group at $32.20 ($55.50−$21.30) — indicating substantial middle-range spread for UnitedHealth Group. The tightest dispersion is Cigna at $13.70 ($40.40−$27.30) and Aetna at $5.00 ($24.00−$19.00), reflecting more concentrated commercial reimbursement bands.