Table of Contents Hide
- What is the description of CPT code 97151?
- What are the types of behavior assessments used in CPT 97151?
- Is CPT code 97151 reimbursable by insurance companies?
- What documentation is needed to support billing for CPT code 97151?
- What are the modifiers used in the 97151 CPT code?
Behavior assessment in medicine refers to evaluating an individual’s behavior and psychological functioning to diagnose and treat mental health conditions. This assessment gathers data that helps people employed in psychology, education, medical billing, and related fields make educated decisions, offer the right help, and keep track of growth over time.
CPT 97151 is one of these codes that is often used in adaptive behavior assessment procedures. The objective of this article is to give you a full picture of this code, how it works, and what it means in ABA procedures.
What is the description of CPT code 97151?
A physician or licensed healthcare practitioner does several in-person tests to evaluate adaptive or maladaptive behavior. He scores the test, analyzes the results, makes a care plan, writes a report, and meets with the parent, guardian, or caregiver to discuss his findings.
CPT 97151 must be reported for each 15 minutes that the provider spends in face–to–face time with the patient and non–face–to–face time analyzing past data.
Related Article: 73562 CPT code
What are the types of behavior assessments used in CPT 97151?
These are some examples of common forms of behavior assessments that may be employed. However, the exact types used will vary based on the needs of the individual and the healthcare provider’s knowledge.
- Functional Behavior Assessment (FBA)
This assessment tries to figure out what the person’s challenging behaviors are. It includes tracking the behavior’s causes, what happens afterward, and what patterns or environmental factors might affect it.
- Direct Behavioral Observations
The systematic study of a person’s behavior in natural or planned settings is part of this assessment. Observers may use standard procedures or checklists to record and rate certain behaviors, like aggression, self-stimulatory behaviors, or social skills.
- Behavioral Rating Scales
These are standard surveys or rating scales that people, their guardians, or teachers can fill out to get subjective information about a person’s behavior, mental health, and social skills. The Behavior Assessment System for Children (BASC) and the Aberrant Behavior Checklist (ABC) are two examples.
- Interviews and Clinical Assessments
It is common for medical professionals to have conversations with individuals, their caretakers, or caregivers to get information about specific behaviors, symptoms, developmental history, and social functioning.
Is CPT code 97151 reimbursable by insurance companies?
Yes, CPT code 97151 is reimbursable by insurance companies, but coverage and reimbursement rates may vary depending on the individual insurance plan and the reason for the service. It’s also important to talk to the healthcare professional or service provider doing the behavior assessment to ensure they know about insurance benefits. It can help with any paperwork or records that must be filled out.
What documentation is needed to support billing for CPT code 97151?
The following documents are needed to support bills for CPT code 97151:
- An extensive evaluation of the patient’s mental health.
- A plan of care based on the assessment results.
- Progress notes that show how the patient is responding to care.
What are the modifiers used in the 97151 CPT code?
Modifiers are added codes used to give more information or clarify certain situations linked to the billing and coding process. The modifiers used in the code 97151 are given as under.
- -LT: Left side
Used to indicate that the service was performed on the left side of the body when applicable.
- -RT: Right side
This modifier indicates that the service was performed on the right side of the body when applicable.
- -50: Bilateral procedure
It indicates that the service was performed on both sides of the body or in a bilateral fashion.
- -59: Distinct procedural service
Used to indicate that the service is a distinct and separate procedure that should not be bundled with other services.
- -76: Repeat procedure or service by the same physician or other qualified healthcare professional
Applied to indicate that the same provider repeated the same procedure or service during the same day.
- -77: Repeat procedure or service by another physician or other qualified healthcare professional
Used to indicate that the same procedure or service was repeated by a different provider on the same day.
Some common challenges or limitations of behavior assessments in 97151?
Behavior tests under CPT code 97151 may tell you a lot about a person’s behavior and help you plan an intervention. Yet, they additionally come with certain challenges or limitations that you should be careful of:
- Subjectivity: Subjective judgments and interpretations of behavior are common in behavior evaluations. This can lead to biases or differences in the results of the assessments.
- Observer Effect: Being watched or knowing you are being protected can change how someone acts and the natural situation.
- Contextual Variability: Behaviors may vary depending on the context or situation in which they occur. Conducting observations or assessments in a controlled setting may not reflect the individual’s behavior in real-life situations.
- Limited Time Sampling: Observations typically occur for a limited duration, which may not provide a comprehensive picture of an individual’s behavior. It is possible to miss important behaviors or variations outside the observation window.
- Reliance on Self-Report or Caregiver Reporting: Behavioral rating scales or interviews often rely on self-reports or reports from caregivers or teachers. Memory biases, social desirability, or subjective interpretations can influence the accuracy of the information provided.
It is important for professionals conducting behavior assessments to be aware of these challenges and limitations and to consider them when interpreting the results and developing intervention plans.