We’re reprocessing certain ABA service claims submitted from Jan. 1 to March 1, 2024
We’re reprocessing claims for Applied Behavior Analysis (ABA) services for CPT code 97153 submitted for commercial and individual members from Jan. 1 through Mar. 1, 2024. These claims originally paid at the 2023 rate and are being reprocessed to pay providers at the increased 2024 rate.
There’s no need to resubmit claims.
Impacted claims submitted as of Mar. 2, 2024, are being reprocessed at the higher 2024 rate automatically. Refer to our provider manual to learn about our timeline and process for correcting payments.
Did you know?
ABA rate increases and a newly covered code Below is an overview of our ABA code reimbursement rates for commercial plans, several of which were increased this year to support our provider network.
Additionally, as of Jan. 1, 2024, we began covering CPT code 97157 for all group commercial plans, allowing providers to offer training and support in a group setting with parents and caregivers whose family members are receiving ABA services.
See our Autism Spectrum Disorders medical policy for more information.