Accepted Insurances

If we are contracted with your insurance company, the only fees you may have to worry about are if you have a deductible, a copay, or co-insurance for ABA Therapy.

To help you find out what those fees might be here are the medical billing codes that we submit to your insurance company:

Behavior identification assessments are administered by a BCBA or other qualified health care professional over two or more appointments. Billing codes are counted by each 15 minute unit of the BCBA's time face-to-face with client and/or guardian(s) / caregiver(s) administering assessments and discussing findings and recommendations; as well as performing non-face-to-face analysis of data, scoring and interpreting the assessment; and preparing the initial assessment report and treatment plan.

The initial ABA assessment is billed once, depending on your insurance company and their requirements and is usually for 6 to 12 hours worth of behavior analytic work.

If approved, the behavior assessment initially or renews the ABA authorization for 6 months of ABA Therapy.  

Insurance limits 16 units/day or 4 hours/day, and no more than 32 units/assessment (every 6 months).

The re-assessment is usually submitted every six months thereafter to prove the medical necessity of the continuation for your insurance company to authorize ABA therapy.

This is where we use the previous 6 months worth of data in graphs to show the insurance company that maladaptive behaviors targeted for reduction have gone down, while showing that replacement skill acquisitions have occurred.

Insurance limits 16 units/day or 4 hours/day, and no more than 16-32 units/assessment (every 6 months)

Observational behavioral follow-up assessment (every 6 months), is administered by an RBT or Student Analyst to assist with initial and re-assessments. 

Insurance limits 8 units/assessment or 2 hours/authorization.

Once a behavior assessments has been submitted and approved by your insurance company, then we provide ABA Therapy for the 6 month authorization period. 

The following billing codes are counted by each 15 minute unit of the RBT, BCaBA, or BCBA's time face-to-face with the client and/or their guardian(s) and caregiver(s). 

We perform analysis of data, scoring & interpreting graphs; implementation of ABA services with behavior skills training; staff & parents training; goal and plan modifications.

97153 is administered by the RBT/BCaBA/BCBA for one-on-one ABA services that are delivered face-to-face with one client.

This may not be conducted via telemedicine, while supervision may under 97155, the RBT, BCaBA, BCBA must be present with the client.

Insurance limits 32 units/day or 8 hours/day, and no more than 160 units/week (40 hours).

Group adaptive behavior treatment by protocol, administered by an RBT, BCaBA, or BCBA, face-to-face with two or more clients. 

Maximum 6 clients per group, service provided by BCBA, BCaBA, or RBT.

Insurance limits 18 units/day or 4.5 hours/day.

97155 is administered by a supervising BCaBA or BCBA for one-on-one ABA services that are delivered face-to-face with one client, whihe ABA supervisor develops new or modified treatment protocol(s).The RBT may be present receiving concurrent supervision under 97153. 

This may be conducted via telemedicine by the BCBA or BCaBA only, however the RBT must be present with the client.

Tust be completed a minimuone time per month by an ABA supervisor. 

Insurance limits 24 units/day or 6 hours/day.

97156 is administered by an authorized ABA supervisor (BCBA or BCaBA), for the treatment guidance to the parents/ caregivers.

Also called "Family Adaptive Behavior Treatment Guidance" or Family Training by Lead Analyst."

First session must be within the first 30 calendar days of the treatment authorization.

A minimum of six parent/caregiver sessions are required every six months.

Insurance limits 8-16 units/day or 2-4 hours/day.

97157 is administered by an authorized ABA supervisor (BCBA or BCaBA), for guiding parents/caregivers (without the client present) to utilize the ABA treatment plan protocols.

Groups must not exceed eight participants.

May not be conducted via telemedicine.

Insurance limits 6-16 units/day or-4 1.5 hours/day.

97158 is administered by an authorized ABA supervisor (BCBA or BCaBA), for the delivery of ABA services with protocol modification,  in groups of two to six/eight clients.

Also called "Adaptive Behavior Treatment Social Skills Group."

Groups must not exceed six (Medicaid) or eight (Tricare) participants.

May not be conducted via telemedicine.

Insurance limits 16 units/day or 4 hours/day.

 "TS" is a modifier used by some insurance plans used to differentiate the reassessment from the initial assessment. 

 "TS" is a modifier used by some insurance plans used to differentiate the reassessment from the initial assessment. 

If you are interested in starting ABA therapy with us, please call us at toll-free (833) 869 - 2423, or fill out the Contact Us, form, and we will email you our intake forms.