Healthcare is already a complicated industry, and medical billing can be additionally complex. The healthcare industry’s growth of telehealth and remote patient monitoring (RPM) has added another layer of complexity. Ensuring compliance and competence for successful telehealth billing is essential for modern healthcare practices.
This is complicated further by the inconsistency in whether payors will allow direct or assessment codes to be rendered via telehealth. Even if a payor does allow it, it’s often plan-specific. So, it’s absolutely critical that you check the current payor clinical or telehealth guidelines and plan benefits to determine whether you can treat and assess ABA patients via telehealth before services are rendered.
With countless providers, platforms, features, and constantly evolving policies, keeping up can seem an overwhelming prospect. Missing Piece has expertise in in-office medical billing, telehealth billing, and ABA billing services to help facilitate the entire process for you.
Let’s delve into some of the most important aspects of the telehealth and remote patient monitoring billing practice.
What is Telehealth and Remote Patient Monitoring?
First, let’s take a quick look at telehealth and RPM and how healthcare providers use them.
Telehealth is a collection of patient metrics and an alternative means of providing in-person treatment. Telehealth has been beneficial for some patients undergoing ABA therapy. Telehealth ABA therapy sessions usually occur via two-way video conferencing or over the phone.
Remote patient monitoring falls under the telehealth umbrella in that remote monitoring devices are used to report readings, patient health information, and data that are then transmitted to clinical professionals who assess and monitor them regularly.
These services allow greater accessibility to medical services for those unable to make it to an appointment in person and allow for easy management of chronic conditions that don’t necessarily require in-person appointments.
How to Bill for Telehealth and Remote Patient Monitoring
One of the main concerns for healthcare practitioners and ABA therapy centers when offering telehealth services is how to remain compliant with telehealth billing codes and other regulatory requirements.
While the anxieties around medical billing for telehealth services and compliance are justified, it is quite simple if you have the right medical billing services provider. Here at Missing Piece, we have the expertise and platforms that simplify the billing process and remove the risk of coding errors in Medicare telehealth billing, among other things.
Our innovative billing platforms are designed to reduce the risk of rejections and denials in ABA medical billing. Some of the most common mistakes that our software and expertise reduce are as follows:
- Incorrect or missing information on the claim form
- Errors in billing and coding
- Prior authorization and referral issues
- Duplicate billing
- Timeliness of filing
Telehealth Codes for ABA Assessment Therapy Billing
The American Medical Association (AMA) Current Procedural Terminology codebook divides adaptive behavioral health services into two categories: Category I (medicine section) and Category III (temporary codes for emerging technology).
These are divided into eight category-I CPT codes and two category-III CPT codes for ABA therapy and behavior services. These detailed categories allow for a more streamlined medical billing service within the ABA industry.
The following codes are used for ABA assessments as from the AMA CPT codebook:
- CPT code 97151 covers the analysis of pertinent past data, including medical diagnosis.
- CPT code 97152 refers to procedures performed by a technician under the direction of a physician or other qualified healthcare professional.
- CPT code 0362T must be administered by a physician or other qualified healthcare professional who is on-site, with the assistance of two or more technicians.
Check whether each patient is covered for ABA assessment via telehealth before booking an appointment.
Do These Codes Apply to Telehealth Billing?
Centers for Medicare & Medicaid Services (CMS) finalized the telehealth Category 2 codes for therapeutic behaviors in January 2024. These include the adaptive behavior/ABA services codes mentioned above (97151-97158, 0362T, 0373T). However, at this time, these do not cover audio-only interactions. This means that therapists and clinical professionals must use video and interactive sessions for ABA therapy in order to qualify for coverage of telehealth billing.
ABA Therapy Treatment Codes
The following ABA treatment codes are covered by telehealth and should be charged per every 15 minutes, according to the AMA CPT codebook:
- 97153: Adaptive behavior treatment by protocol, administered by a technician under the direction of a physician or other qualified healthcare professional, face-to-face with one patient.
- 97155L: Adaptive behavior treatment with protocol modification, administered by a physician or other qualified healthcare professional, which may include simultaneous direction of technician, face-to-face with one patient.
- 0373T: Adaptive behavior treatment with protocol modification, each 15 minutes of technician’s time face-to-face with a patient.
- 97154: Group adaptive behavior treatment by protocol, administered by a technician under the direction of a physician or other qualified healthcare professional, face-to-face with two or more patients.
- 97158: Group adaptive behavior treatment with protocol modification, administered by a physician or other qualified healthcare professional, face-to-face with multiple patients.
- 97156: Family adaptive behavior treatment guidance, administered by a physician or other qualified healthcare professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s).
- 97157: Multiple-family group adaptive behavior treatment guidance, administered by a physician or other qualified healthcare professional (without the patient present), face-to-face with multiple sets of guardians/caregivers(s).
- 97158: Group of two or more people, adaptive behavior treatment guidance, administered by a physician or other qualified healthcare professional (without the patient present), face-to-face with multiple sets of guardians/caregivers, each 15 minutes.
Check whether each patient is covered for ABA treatment via telehealth before booking an appointment.
Consolidate and Simplify Telehealth Medical Billing With Missing Piece
As an experienced medical health billing company, we understand your practice, the variety of treatment options and methodologies, and the documentation needed for telehealth billing and authorization.
We ensure that every component of your telehealth billing process is properly managed so that you can maintain relationships with clients who may be unable to come in for a face-to-face appointment. With the help of our innovative billing solutions, you can reach more clients and make a bigger difference with your ABA therapy services. Contact us for more information about how we can help you.