Applied Behavioral Analysis 2019 CPT Code Crosswalk HEALTH SYSTEMS DIVISION Medicaid Program Unit
Applied Behavioral Analysis ORABA Presentation • Introduction • Purpose • 2019 ABA code crosswalk • Information about current work • Discussion around partnership and expectations HEALTH SYSTEMS DIVISION Medicaid Program Unit 2
Introduction • Donny Jardine • Why am I here • Background HEALTH SYSTEMS DIVISION Medicaid Program Unit 3
Purpose • Introductions- be able to meet Oregon provider and put a face to a name • Information and changes resulting in current ABA codes • Opening lines of communication and providing an opportunity for collaboration • Gather feedback and ideas from Oregon ABA providers HEALTH SYSTEMS DIVISION Medicaid Program Unit 4
2019 CPT Code Crosswalk • CPT codes for Applied Behavioral Analysis have been updated and effective January, 1, 2019. • Health Systems Division Leadership approved a cost neutral approach to updating CPT codes. • Some old codes did not crosswalk directly to new codes, resulting in changes to the use of old codes HEALTH SYSTEMS DIVISION Medicaid Program Unit 5
Assessment • Previous Code 0359T – This code was reimbursable at $400 per assessment • Current Code 97151 – Reimbursement was configured under the direction of OHA leadership in conjunction with ABA providers and other behavioral health analyst. – Intent was to offer a cost neutral solution and maintain the $400 assessment rate. – Reimbursement was capped at 8 hours per assessment. • Providers can complete an ABA assessment quarterly HEALTH SYSTEMS DIVISION Medicaid Program Unit 6
Assessment Continued • Previous Codes 0362T and 0363T – Used to support the ABA assessment for high needs patients – 0362T was administered by one technician, under the direction of a physician or other qualified healthcare professional face-to-face with the patient – 0363T was administered by the physician or other qualified healthcare professional with the assistance of one or more technicians • 0362T – This code is no longer reimbursable to the Oregon Health Plan. • Previous use was almost exclusive to inpatient providers – Language change on this code changed beginning on January 1, 2019 to include the physician or other qualified health care professional AND the assistance of two or more technicians HEALTH SYSTEMS DIVISION Medicaid Program Unit 7
Assessment Continued • Current Codes – 97152 Reimbursable at $12.50 per unit – Limited to 2 hours – Can be completed quarterly in conjunction with 97151 – Can be completed by a technician under the direction of a physician or other qualified healthcare professional • Matching the rate of 97151 was intentional HEALTH SYSTEMS DIVISION Medicaid Program Unit 8
Individual Treatment • Previous Codes: 0364T, 0365T, 0368T and 0369T – Codes were reimbursable in 30-minute intervals – 0368T and 0369T were administered by a physician or other qualified healthcare professional • Current Codes: 97153 and 97155 – Codes are now reimbursable at 15-minute units – Under direction of leadership, these codes were implemented in a cost neutral way – 97155 allows for treatment and simultaneous “supervision” of technician HEALTH SYSTEMS DIVISION Medicaid Program Unit 9
Group Treatment • Previous Codes: 0366T and 0367T – Codes were reimbursable at 30-minute intervals – Codes were broken down and rates were considered for group sizes of 1 to 5 individuals • Current Code: 97154 – Group services are reimbursable in 15-minute units. – After consulting with other ABA programs, Oregon ABA providers, and other Analysts, average groups size was determined to be 3 individuals – Reimbursement was based on the average group size HEALTH SYSTEMS DIVISION Medicaid Program Unit 10
Family Behavior Treatment • Previous Codes: 0370T and 0371T – These were billable in 60-75 minute intervals – Reimbursement was broken down and rates considered for family treatment, without the patient present, for 1-5 families • New Codes 97156 and 97157 – Reimbursement is provided in 15-minute units – Reimbursement rate was configured based on 5 15-minute units, which correspond to the previous 75 minute interval. – Multiple-Family Group services were considered in the same way as group services, resulting in an average of 3 families per group. HEALTH SYSTEMS DIVISION Medicaid Program Unit 11
Current Work • I have asked providers to bill the total number of hours needed to complete an assessment • I will complete an analysis in Quarter 1 of 2020 to evaluate the length of time a typical assessment takes to complete. • Assessment information will be compared to industry standards and taken into consideration when rates for ABA service are reviewed. • I want to develop an open line of communication for ABA providers to discuss policies and partnership opportunities HEALTH SYSTEMS DIVISION Medicaid Program Unit 12
Discussion • Questions HEALTH SYSTEMS DIVISION Medicaid Program Unit 13
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