New Codes for Adaptive Behavior Assessment and Treatment

Posted March 27, 2015 

Last year, the American Medical Association (AMA) created a new set of Current Procedural Terminology (CPT®) codes to describe Adaptive Behavior Assessment and Treatment.

According to the AMA, these CPT codes were created to be used by any physician or other qualified health care professional, to report services rendered to patients of any age with Autism Spectrum Disorders (ASDs). This also applies to other diagnoses or conditions, such as developmental disabilities or head trauma, that are associated with deficient adaptive or maladaptive behaviors (e.g., impaired social skills and communication deficits, destructive behaviors and additional function limitations secondary to maladaptive behaviors).

Effective July 1, 2015, claims submitted by Board Certified Behavioral Analyst and Developmental Therapists will only be considered eligible for benefits by Blue Cross and Blue Shield of Illinois if the services described on the claims are those specified in the new Adaptive Behavior Assessment and Treatment CPT codes.

Refer to the April 2015 Blue Review for further information and a listing of the new CPT codes and their descriptions.

This material is for educational purposes only and is not intended to be a definitive source for what codes should be used for submitting claims for any particular disease, treatment or service.  Health care providers are instructed to submit claims using the most appropriate code based upon the medical record documentation and coding guidelines and reference materials.

CPT copyright 2014 AMA. All rights reserved. CPT is a registered trademark of the AMA.