0373T — Adapt bhv tx ea 15 min
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Recommendation for ABA from a qualified licensed health care provider working within their scope of practice and qualified to diagnose ASD.
- Clinical documentation confirming ASD diagnosis per the most current DSM criteria or state-defined ABA criteria.
- Documentation of ASD severity level.
- Record of the screening tool used to confirm the ASD diagnosis, including tool name and results.
Key Coverage Criteria
- SCQ: screening for social communication deficits suggestive of autism spectrum disorder
- ASSQ: screening for autism spectrum traits (typically school-aged children)
- STAT: brief interactive screening for autism in toddlers and young children
- Applied behavior analysis (ABA) for treatment of autism spectrum disorder (ASD), which may require treatment at any point in life
- ABA services to increase adaptive skills such as language, self-help, and play.
- ABA services to decrease targeted maladaptive behaviors such as aggression, self-stimulatory behaviors, and self-injury.
4 Active Policies
AMBETTER-CP.BH.104 — Applied Behavior Analysis
AMBETTER-CP.BH.105 — Applied Behavioral Analysis Documentation Requirements
PSY301.021 — Applied Behavior Analysis (ABA) for Autism Spectrum Disorder (ASD) Diagnosis
REGENCE-BH18 — Applied Behavior Analysis for the Treatment of Autism Spectrum Disorders
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.