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97153 is another CPT code under “Adaptive Behavior Treatment Procedures” by the American Medical Association. This code is typically utilized when professionals need to modify a standardized treatment protocol to better suit an individual’s unique needs during the assessment process.
What is the CPT code 97153 description?
CPT 97153 code refers to adaptive behavior assessment conducted through direct interaction and observation of the individual. It involves in-person evaluation by professionals who directly engage with the individual to assess their adaptive behavior.
This assessment may include structured activities, role-playing, or other interactive methods to evaluate the individual’s skills and level of independence in various adaptive domains. The overall time lasts between 15 – 17 minutes.
What are the documents needed to bill CPT 97153?
Being a medical enthusiast or a passionate learner, you need to know what documents are required for billing 97153.
- A datasheet with the dates, hours, locations, services, and signatures of the guardians and technicians should be in the possession of the person facilitating the session.
- Every in-person encounter for which 97153 is billed should have a data sheet including those essential details.
- To support the use of those hours or units, you will also need to develop goals with quantitative data.
- If you are ever audited, these data must be logged and graphed. Electronic data-collecting software is, of course, another option.
What services does 97153 code include?
CPT code 97153 includes:
Adaptive Behavior Assessment: This involves formally evaluating an individual’s adaptive behavior, which includes their ability to perform everyday life skills necessary for personal and social independence.
Assessment Modification: The assessment may need to be modified or adapted to meet the specific needs of the individual being assessed. This ensures that the assessment is appropriate and fair for the evaluated person.
Individualized Interaction and Observation: During the assessment process, the assessor will interact individually with the individual being assessed. This may involve direct observation, interviews, and other methods of gathering information about the individual’s behavior.
Data Collection: Data is collected during the assessment to document the individual’s performance in various areas of adaptive behavior. This data is crucial for the assessment process and may include both qualitative and quantitative information.
Assessment Report Generation: After the assessment is complete, a formal assessment report is generated. This report typically includes findings from the assessment, recommendations, and any necessary information for treatment planning or educational interventions.
Direct 1:1 therapy between the client and the registered technician. This includes:
- NET activities
- Behavior modification protocols
- Task analyses
What is the modifier for 97153 CPT code?
Modifier 97, 59:
It is used to bill CPT code 97153. It is commonly known as the “simultaneous or overlapping care” modifier, indicating that the adaptive behavior assessment performed with protocol modification is separate and distinct from other services provided to the patient on the same day by the same practitioner.
This modifier describes a specified degree of service. It addresses the lower-intensity, time-limited treatment focused on particular issues or behaviors.
Modified TF – 52:
It is used along with the modifier TF to denote an even higher degree of focused behavior treatment that technicians or other healthcare providers can provide.
When a resident performs a service supervised by a teaching physician, the modifiers TG and TF are utilized in medical billing. “Resident services performed under direct supervision” is represented by TF, while “resident services performed without direct supervision” is characterized by TG.
CPT code 97153 and telehealth services
97153 is a CPT code used for adaptive behavior treatment services. If the therapist is licensed in the state where the patient resides and telehealth is an effective means of delivering treatment, it can be used for telehealth services.
The modifier for CPT code 97153 is “modifier U7”. This modifier is used to indicate that the service was provided via telehealth.
What is the difference between 97152 and 97153?
CPT codes 97152 and 97153 fall under Adaptive Behavior Assessment Procedures, but they represent different assessment services and methodologies.
The primary distinction between both CPT codes are the adaptive behavior assessment techniques. While code 97153 requires direct interaction and observation, code 97152 depends on standardized equipment. The particular assessment method employed, as well as the assessing professional’s preferences, will determine which of the two codes is selected.
CPT code 97153 insurance coverage
The individual’s particular insurance policy and the rules established by their insurance provider determine the scope of coverage for CPT code 97153. It is crucial to study the insurance policy, communicate with the insurance company directly, or contact the healthcare professional for clarity, as it may differ depending on the insurance plan.
Insurance companies usually have a list of services they cover, and some tests or procedures might need to be pre-approved or fulfill certain requirements before they can be reimbursed. It is advisable to verify and obtain any required pre-authorization before undergoing an adaptive behavior assessment using CPT code 97153 to ensure that the insurance plan covers services.