The ACD adopted the new Category I CPT codes that directly transferred from the Category III codes. Specifically, the ACD has adopted 97151, 97153, 97155 and 97156. Providers should use the approved new codes for all services provided on or after January 1, 2019.
Due to the changes in ACD CPT codes, DHA has authorized four additional hours (16 units) of 97155 per month per beneficiary to ensure adequate time is allowed with each beneficiary for protocol modification. You do not need to request any changes to your authorization. Please reevaluate your treatment plans for the next authorization period and request units appropriately.
There are several key changes:
“There has been a change to the law regulating Applied Behavior Analytic providers in the state of Texas effective September 1, 2018. Behavior analysts and assistant behavior analysts must be licensed by the Texas Department of Licensing and Regulation in order to participate in the ACD and provide services under that demonstration. For more detailed information regarding the changes to this law please refer to this website."
“There has been a change to the law regulating Applied Behavior Analytic providers in the state of Texas effective September 1, 2018. This change will specifically affect assistant behavior analysts with the designation of Qualified Autism Services Practitioner (QASP) or Qualified Autism Services Practitioner-Supervisor (QASP-S). Behavior analysts and assistant behavior analysts must be licensed by the Texas Department of Licensing and Regulation in order to participate in the ACD and provide services under that demonstration. The QASP/QASP-s will no longer be eligible for Texas licensure and as a result will not be eligible to participate in the TRICARE ACD as an assistant behavior analyst. Therefore, these providers will no longer be able to provide supervision to ABA recipients nor receive TRICARE reimbursement at the “assistant behavior analyst” level. However, they may continue to practice ABA services at the level of a “behavior technician” providing they meet the requirements outlined in the TRICARE Operations Manual Chapter 18, Section 4, Paragraph 6.3 and comply with applicable state legislation. For more detailed information regarding the changes to this law please refer to this website."
All ABA providers must be TRICARE-certified. To become an ABA TRICARE-certified provider, please complete the appropriate form and fax to (608) 221-7544.
All behavior analysts must be credentialed if they choose to become a network provider. Apply to become a TRICARE network provider
ABA providers are considered outpatient specialty providers. Authorized ABA supervisors and ACSPs are allowed to bill for ABA services.
All claims must be submitted electronically with Wisconsin Physicians Service (WPS) in order to receive payment for services. Claims can take up to 30 days to process. All claims for benefits must be filed no later than one year after the date the services were provided. Network providers can submit new claims and check the status of claims online using provider self-service. Log in or register
In accordance with TOM Chapter 18 Section 4, prior authorization is required prior to rendering ABA services. Claims for services rendered without prior authorization will be denied. All claims must be submitted by BCBA/BCBA-D for services covered under the Autism Care Demonstration (ACD).
*Please note: For telemedicine, the GT modifier must be used.
Changes to CPT codes for ABA were implemented on 1/1/2019. Learn more
Topics covered include TRICARE certification requirements, Humana Military credentialing requirements,
referrals and authorizations, claims requirements, forms and key provider resources.
The quickest, most efficient way to request ABA services is online through provider self-service. Providers may also fax referrals and supporting documentation to (877) 378-2316.