New Healthcare Common Procedure Coding System (HCPCS) Category III Codes for Adaptive Behavior Assessment and Treatment
Effective July 1, 2014
The following Category III Health Care Common Procedure Coding System (HCPCS) codes are effective July 1, 2014, and reflect services related to adaptive behavior assessment and treatment. According to the American Medical Association (AMA), these codes may be applicable to "patients of any age with autism spectrum disorders (ASDs) or other diagnoses or conditions...associated with deficient adaptive or maladaptive behaviors."
Category III codes are temporary codes that are covered at the discretion of payers, including local Medicare Administrative Contractors and state Medicaid agencies. State practice acts may also determine who can provide and receive these services. Speech-language pathologists interested in using these codes should contact payers directly for additional information on coverage and payment.
All codes and descriptions are copyright of the American Medical Association.
Adaptive Behavior Assessments
| Code | Descriptor |
|---|---|
| 0359T | Behavior identification assessment, by the physician or other qualified health care professional, face-to-face with patient and caregiver(s), includes administration of standardized and non-standardized tests, detailed behavioral history, patient observation and caregiver interview, interpretation of test results, discussion of findings and recommendations with the primary guardian(s)/caregiver(s), and preparation of report |
| 0360T | Observational behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by one technician; first 30 minutes of technician time, face-to-face with the patient |
| 0361T | Each additional 30 minutes of technician time, face-to-face with the patient (List separately in addition to code for primary service) |
| 0362T | Exposure behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by physician or other qualified health care professional with the assistance of one or more technicians; first 30 minutes of technician(s) time, face-to-face with the patient |
| 0363T | each additional 30 minutes of technician(s) time, face-to-face with the patient (List separately in addition to code for primary procedure) (Use 0363T in conjunction with 0362T) (0362T and 0363T are reported based on a single technician's face-to-face time with the patient and not the combined time of multiple technicians) |
Adaptive Behavior Treatment
| Code | Descriptor |
|---|---|
| 0364T | Adaptive behavior treatment by protocol, administered by technician, face-to-face with one patient; first 30 minutes of technician time |
| 0365T | Each additional 30 minutes of technician time (List separately in addition to code for primary procedure) (Use 0365T in conjunction with 0364T) (Do not report 0364T and 0365T in conjunction with 90785-90899, 92507, 96101-96155 or 97532) |
| 0366T | Group adaptive behavior treatment by protocol, administered by technician, face-to-face with two or more patients; first 30 minutes of technician time |
| 0367T | Each additional 30 minutes of technician time (List separately in addition to code for primary procedure) (Use 0367T in conjunction with 0366T) (Do not report 0366T and 0367T if the group is larger than eight (8) patients) (Do not report 0366T and 0367T in conjunction with 90785-90899, 92508, 96101-96155 or 97150) |
| 0368T | Adaptive behavior treatment with protocol modification administered by physician or other qualified health care professional with one patient; first 30 minutes of patient face-to-face time |
| 0369T | Each additional 30 minutes of patient face-to-face time (List separately in addition to code for primary procedure.) (Use 0369T in conjunction with 0368T.) (Do not report 0368T and 0369T in conjunction with 90791, 90792, 90846, 90847, 90887, 92507, 97532) |
| 0370T | Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present) |
| 0371T | Multiple-family group adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present) (Do not report 0371T when the families of more than eight (8) patients are participants) (Do not report 0370T and 0371T in conjunction with 90791, 90792, 90846, 90847 or 908887) |
| 0372T | Adaptive behavior treatment social skills group, administered by physician or other qualified health care professional face-to-face with multiple patients (Do not report 0372T if the group is larger than eight (8)) (Do not report 0372T in conjunction with 90853, 92508 or 97150) |
| 0373T | Exposure adaptive behavior treatment with protocol modification requiring two or more technicians for severe maladaptive behavior(s); first 60 minutes of technicians' time, face-to-face with patient |
| 0374T | Each additional 30 minutes of technicians' time face-to-face (Use 0374T in conjunction with 0373T) (0373T and 0374T are reported based on a single technician's face-to-face time with the patient and not the combined time of multiple technicians) (Do not report 0373T and 0374T in conjunction with 90755-90899 or 96101-96155) |
