Adaptive Behavior Support (ABS) Services Coding and Fee Schedule
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Governs coding, billing rules, unit rates, provider levels, team composition, prior authorization triggers, and fee schedule entries for ABS services reimbursed by the Illinois Department of Healthcare and Family Services; affects HFS-enrolled BCBAs, ABS-certified developmental clinicians, RBTs, and developmental technicians.
No material clinical or coverage changes in this revision.
Coverage and Billing Rules
Coverage and billing rules
General coverage and billing rules for Adaptive Behavior Support (ABS) services as listed on the HFS fee schedule.
ALL of the following
ALL of the following
ALL of the following
- Use GT or 93 modifier only when providing allowable service remotely as a distant site telehealth service along with Place of Service (POS) 02 or 10 on the service line.
- Use HT modifier only for services, assessments, or evaluations performed by a coordinated team of qualified professionals.
ABS Service Codes, Units, and Limits
| 97151 | Behavior Identification Assessment |
| 97152 | Behavior Identification Supporting Assessment |
| 0362T | Functional Analysis of Severe Maladaptive Behaviors in Specialized Settings |
| 97153 | Adaptive Behavior Treatment by Protocol |
| 97154 | Group Adaptive Behavior Treatment by Protocol |
| 97155 | Adaptive Behavior Treatment with Protocol Modification |
| 97156 | Family Adaptive Behavior Treatment Guidance |
| 97157 | Multiple Family Group Adaptive Behavior Treatment Guidance |
| 97158 | Group Adaptive Behavior Treatment with Protocol Modification |
| 0373T | Direct Treatment of Severe Maladaptive Behavior in Specialized Settings |
Prior Authorization, Modifiers, and Telehealth Billing
Obtain prior authorization for specified ABS assessments and many treatment codes
Prior authorization is required for specified ABS assessments and many treatment codes. Specifically, prior authorization is required if Behavior Identification Assessment (97151), Behavior Identification Supporting Assessment (97152), or Functional Analysis (0362T) exceed 6 hours; many treatment codes (e.g., 97153, 97154, 97155, 97156, 0373T) are listed on the fee schedule with Prior.Authorization = Yes.
- 97151 — Prior.Authorization = Yes if >6 hours (Daily max quantity = 8; Units = 1/4 hr).
- 97152 — Prior.Authorization = Yes if >6 hours (Daily max quantity = 8; Units = 1/4 hr).
- 0362T — Prior.Authorization = Yes if >6 hours (Daily max quantity = 8; Units = 1/4 hr).
- 97153, 97154, 97155, 97156, 0373T — treatment codes indicated with Prior.Authorization = Yes on the fee schedule.
Use GT/93 for telehealth (with POS 02 or 10) and HT for coordinated team services
Apply telehealth and team modifiers exactly as specified: use GT or 93 for distant-site telehealth services and report POS 02 or 10 on the service line; use HT for services or assessments performed by a coordinated team.
- Use GT or 93 modifier only when providing the allowable service remotely as a distant site telehealth service and include Place of Service (POS) 02 or 10 on the specific claim line.
- Use HT modifier only for services, assessment, or evaluation performed by a coordinated team of qualified professionals (team-based services have team rates for certain codes).
Provider Levels and Team Staffing
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