Billing of Applied Behavior Analysis with Speech, Occupational, and/or Physical Therapies
Customize your policy alerts
Sign up for all Blue KC policy alerts
Know when Blue KC releases new policies or updates existing guidance.
Monitor payer policy activity
Defines billing rules for concurrent or overlapping Applied Behavior Analysis (ABA) services with speech, occupational, and/or physical therapies, applicable to professional providers under Blue KC lines of business.
No material clinical or coverage changes in this revision.
When ABA May Be Billed or Provided via Telehealth
Applicable CPT Codes and Coding Guidance for ABA
| 97153 | Adaptive behavior treatment by protocol; technician-administered, each 15 minutes |
| 97155 | Adaptive behavior treatment with protocol modification; analyst-administered, each 15 minutes |
| 97151 | Behavior identification assessment, each 15 minutes |
| 97156 | Family adaptive behavior treatment guidance, each 15 minutes |
| 97152 | Adaptive behavior treatment by protocol (listed as not allowed via telehealth) |
| 97154 | Group adaptive behavior treatment (listed as not allowed via telehealth) |
Billing Rules and Provider Responsibilities
Allow overlap of 97153 and 97155 only with different QHPs and correct modifiers
Codes 97153 (technician-administered) and 97155 (analyst-administered) may overlap only when the descriptors of each code are met and different qualified health providers deliver the services. A single provider may not bill 97153 and 97155 concurrently. Registered Behavior Technicians (RBTs) cannot bill directly and must bill under a BCBA; use modifier HM to identify RBT-delivered services and modifier HO for BCBA-delivered services. Failure to use these modifiers may result in denial.
Do not bill ABA and speech/OT/PT for the same time block
ABA services may not be billed when performed in the same block of time as speech, occupational, or physical therapy; billing standards require only one service and one provider be designated for a given time block. Services provided at different, non-overlapping times on the same day remain billable.
- Concurrent billing of ABA with speech, occupational, or physical therapy during the same time block is not allowed.
- If services occur in non-overlapping time blocks (e.g., ABA noon–1 p.m., OT 1–2 p.m.), both may be billed.
Key Terms and Modifiers
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.