As we get further into 2025, Applied Behavior Analysis (ABA) therapy providers are facing a period of heightened financial uncertainty. At the center of the conversation are the proposed Medicaid cuts — federal and state-level decisions that could have lasting effects on access, reimbursement, and the operational sustainability of behavioral health services in the United […]
Author: Diksha Upadhyay
Keeping ABA Clinics Profitable in 2025
Revenue Risk in 2025: How ABA Practices Can Stay Profitable In 2025, ABA therapy practices, among many other healthcare providers, are navigating one of the most uncertain financial landscapes in recent history. Despite the demand for Applied Behavior Analysis (ABA) therapy continuing to grow, providers are now facing potential policy shifts, increased staffing shortages, and […]
Case Study: Holding Golden Rule Accountable in Florida and Indiana
Total Client Impact: Over $620,000 in Recovered Revenue | Two States, Two Systemic WinsKey Outcomes: Misrepresentation Corrected in FL | DOI Intervention in IN Florida: Correcting Misrepresentation and Securing Full-Year Coverage The ChallengeIn 2013, families affiliated with the Florida Institute of Technology (FIT) purchased Golden Rule insurance plans based on broker assurances that ABA therapy […]
Case Study: Correcting Systemwide Denials for CPT 0373T with Indiana Medicaid
Client Impact: $500,000 in Paid Claims | Resolution Time: 4 MonthsIndustry Impact: Statewide System Fix for All ABA Medicaid Providers The ChallengeIn Indiana, ABA providers faced a critical billing disruption when CPT 0373T—a Category III code essential for adaptive behavior treatment with protocol modification—was excluded from Indiana Medicaid’s provider-to-procedure code linkage system. This oversight resulted […]
Case Study: Bridging the Gap Between Blue Cross Blue Shield of Texas and Blue Cross Blue Shield of South Carolina
Client Impact: $350,000 in Paid Claims | Resolution Time: 1 year and 35 Days The ChallengeA provider partnered with Missing Piece ABA Billing experienced claim denials from Blue Cross Blue Shield of Texas (BCBS TX) for CPT 97153, an essential ABA therapy code. While BCBS TX requires specific modifiers on these claims, all submissions were […]