Mastering your ABA billing can be a powerful tool in your practice. It can unlock new growth opportunities, support strong cash flow management, and eliminate insurance denials. Each of these advantages contributes to a sound financial foundation for your practice.
However, creating a robust ABA billing function takes time and dedication. In this guide, we’ll outline the ABA billing fundamentals you need to know in 2026. We’ll cover the ABA billing cycle, common reasons for billing denials and how to overcome them, and billing best practices that promote efficiency and can help your practice scale.
Understanding the ABA Billing Cycle
Before we get into ABA billing best practices, let’s first cover the fundamentals of the billing cycle. ABA billing begins before services are even offered. In fact, your billing team will go through pre-authorizations before a new patient is accepted. Here’s the typical ABA billing cycle:
Step 1) Eligibility and Benefits Pre-Authorization
Once a patient makes an appointment, your team will verify that their insurance provider covers the initial visit. Your billing team should reach out to the patient to either confirm or deny coverage. While an insurance provider might cover the initial visit, they can reject future visits. Your BCBA will conduct an initial evaluation to determine how many potential visits are needed. This will then be submitted to the insurance provider for approval.
Step 2) Submit Claim
After services are provided, your billing team will submit a claim to the insurance provider. During the visit, the BCBA should have taken thorough session notes that will help the billing team create an accurate claim. Your claim should include:
- Authoundern – As a part of the pre-billing process, your team should have verified the number of units the insurance provider will cover. If your BCBA finds that more units are needed, the claim will need to be adjusted before it is submitted.
- CPT Code – Each claim will include a Current Procedural Terminology (CPT) code and a modifier. These are used to describe the specific services provided. Your billing team will double-check the CPT code by evaluating your session notes.
- Provider Credentials – The billing team will also verify that the provider credentials match the level of service and the payer’s requirements.
- Session Notes – Each payer will have different session note requirements. Your billing team will ensure that the session notes meet the specific requirements prior to submission.
BCBA vs. RBT Billing
If you have a growing practice, you might have a handful of Registered Behavior Technicians (RBTs) on your team. Just like the level of services differs, so do the ABA modifier and the payer’s requirements. Certain providers won’t require you to differentiate between BCBAs and RBTs, while others will. Knowing your provider’s requirements will be crucial to submitting accurate claims.
Step 3) Provider Review
Next, the provider will review your claim. If everything checks out, they will issue a payment. However, if there are errors, they will request more information or deny the claim altogether. Claim denials can be difficult to overturn, which is why it’s important to verify that all information is accurate beforehand.
ABA CPT Codes
During the claim process, you will submit CPT codes that let the provider know the type of services rendered. Currently, there are ten CPT codes that are used. These codes are further broken down into Category I and Category III codes. Category I codes relate to routine services, while Category III codes describe emerging technology. Here’s a brief overview of applicable codes, according to the ABA Coding Coalition:
Adaptive Behavior Assessment CPT Codes
Category I
- 97151. Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician’s or other qualified health care professional’s time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan
- 97152. Behavior identification supporting assessment, administered by one technician under the direction of a physician or other qualified health care professional, face-to-face with the patient, each 15 minutes
Category III
- 0362T. Behavior identification supporting assessment, each 15 minutes of technicians’ time face-to face with a patient, requiring the following components:
- administered by the physician or other qualified health care professional who is on site,
- with the assistance of two or more technicians,
- for a patient who exhibits destructive behavior,
- completed in an environment that is customized to the patient’s behavior.
Adaptive Behavior Treatment Codes
Category I
- 97153. Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes
- 97154. Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with two or more patients, each 15 minutes
- 97155. Adaptive behavior treatment with protocol modification administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes
- 97156. Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes
- 97157. Multiple-family group adaptive behavior treatment guidance, administered by a physician or other qualified healthcare professional (without the patient present), face-to-face with multiple sets of guardians/caregivers, every 15 minutes
- 97158. Group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional face-to-face with multiple patients, each 15 minutes
Category III
- 0373T. Adaptive behavior treatment with protocol modification, each 15 minutes of technicians’ time face-to-face with a patient, requiring the following components:
- administered by the physician or other qualified health care professional who is on site,
- with the assistance of two or more technicians,
- for a patient who exhibits destructive behavior,
- completed in an environment that is customized to the patient’s behavior.
ABA Billing Modifiers
In addition to CPT codes, your billing team will use modifiers that describe your credentials. Here are a few of the common modifiers:
- HO – ABA supervisor, such as a BCBA, provided the services
- HN – Staff with a bachelor’s degree and a BCBA provided the services
- HP – BCBA with a doctoral-level degree provided the services
- HM – RBT or staff member with a bachelor’s degree provided the services
It’s important to note that these modifiers can vary by state, by insurance provider, and by the type of services provided. Always check with your provider before submitting a claim.
Five Common ABA Billing Denials and How to Avoid Them
Mistakes can happen in the ABA billing process. Here are five common reasons why your claim might be denied and how to avoid them.
1) Incomplete Claims
The claim process requires numerous pieces of information, such as session notes, CPT codes, modifiers, and other documentation related to the visit. Missing just one of these components can cause your claim to be denied, as insurance providers want thorough documentation to verify the necessity and types of services rendered.
Solution: To avoid denied claims due to missing documentation, establish an internal checklist for your billing team to follow. Before a claim is submitted, your team will ensure each component is checked off. This checklist can be completed with practice management software. By taking a proactive approach, you can streamline your billing process and reduce the risk of claim denials due to incomplete information.
2) Improper Billing Codes
As we touched on earlier, each claim will have a CPT code. Applying the wrong CPT code, putting the wrong session length, or having mismatching service modifiers can all result in claim denials. Coding issues are especially common when there are multiple therapists working on each patient.
Solution: To prevent improper billing codes, there are a few different strategies you can adopt. First, require your team to take in-depth session notes. Your billing team can look back on these notes to verify the CPT code attached to the claim. Next, your team should be trained on billing codes. While your therapists might not be the ones submitting the bills, having an idea of the different codes can be helpful, especially when it comes to differing provider requirements. Finally, investing in a billing system to streamline your coding can be helpful.
3) Poor Proof of Medical Necessity
Insurance providers will only pay claims that they deem medically necessary. Failure to prove that the services you provide are a necessity can lead to an automatic claim denial.
Solution: While the requirements for proving medical necessity vary by provider, many require detailed documentation of the patient’s diagnosis, progress with each session, a clear treatment plan, and specific evidence to show that ABA therapy is required to fix the underlying issue. For each patient, session notes and treatment plans should contain detailed information and documentation that shows medical necessity and progress. The more detailed your team can be with notes and claim attachments, the lower the likelihood of a claim denial.
4) Expired Authorizations
ABA credentialing is usually required before insurance providers will accept claims. This credentialing process requires ongoing maintenance to keep the authorization active. Missing requirements and renewals can result in automatic claim denials.
Solution: Avoiding expired authorizations relies on tracking renewal dates. First, have a calendar dedicated to renewal dates. Each provider may have a different renewal date, so having a central location to track important deadlines can be helpful. In addition, assign a team member to the renewal process. This team member will track upcoming renewals, gather applicable information, and ensure deadlines are met.
5) Going Over Service Limits
Insurance providers only cover medically necessary treatments. For example, they might only cover a one-hour session once a week. Going over this service limit without approval can cause a denial.
Solution: Before providing a service, review the patient’s policy and coverage. Pre-authorization is usually done after the initial consultation; however, as the patient’s course of treatment changes, your billing team needs to get updated approval. Managing service limits is a joint effort between your therapists and your billing team. If your therapists believe additional treatment is necessary, they should let your billing team know to gain approval before services are provided.
Five Strategies for Effective ABA Billing
Now that we’ve covered an overview of the ABA billing process and common reasons for claim denials, let’s go through a few different strategies that contribute to effective ABA billing.
1) Know Your Payers
By now, you should know that each insurance provider has different requirements and billing processes. While it would be nice to use only one provider, this isn’t a reality for growing practices. With each new payer you add to your list, make a short list of applicable information, like CPT codes, payout limits, and modifier rules. Similarly, track authorization renewals for each payer to avoid missing deadlines.
2) Leverage ABA Automation Tools
The good news about ABA management is that you don’t have to keep track of everything with a pen and paper. In fact, there are countless automation tools at your disposal. Even if you don’t have a large budget to invest in automation tools, there are a few different resources that you can use that won’t break the bank. This could be a calendar management tool to track deadlines or an overall billing management system that handles your entire billing function. Finding the right tools for your practice can save your billing team time and keep everything organized.
3) Invest in Team Training
Your team won’t know how to improve without the proper training. Take the time to host short training sessions that demonstrate billing best practices and the “why” behind documentation requirements, like session notes. Additionally, have written policies and procedures for your team to follow, such as an “ABA Billing Guide.” Having a source that your team can review when assigning billing codes or creating session notes can help reduce errors in your billing process. Finally, hold open commentary sessions where your team can ask clarifying questions and suggest improvements.
4) Prioritize Cash Flow Management
Your job isn’t done once a claim is submitted and approved. In fact, you need to track that the funds actually clear your bank account. Reconcile payments on a regular basis, such as weekly, to make sure your deposits match your billing system. This allows any mistakes to be promptly followed up on. As your practice begins to grow, it can also be helpful to track metrics, such as the turnaround time for claim processing and your denial rate, to find additional ways to improve your billing function.
5) Use an ABA Billing Expert
You won’t have all of the answers, which is why billing experts can be a powerful tool. Working with a medical billing company ensures that your claims are submitted with complete information on a timely basis. This can improve your cash flow management, reduce your denials, and infuse efficiency into your practice. Billing experts also give you the opportunity to focus on other core areas of your practice, such as taking on new patients, marketing in your local area, or simply having a break from time to time.
Summary
ABA billing doesn’t have to be complicated. While there are important steps and requirements in the process, having proper organization is key to success. If you’re looking for new ways to improve your ABA billing, reach out to our team of billing experts today.