Applied Behavior Analysis (ABA) providers are required to maintain progress notes that relate to the goals and objectives outlined in the beneficiary’s Treatment Plan (TP). These notes must correspond to ABA claims filed for that beneficiary.

Providers do not need to submit progress notes with claims; however, Humana Military will request progress notes during ABA quality audits. Humana Military will compare the progress note(s) to the provider’s claims to verify documentation compliance and the adequacy to support the billed charges.

Required progress notes elements

This list is not all-inclusive. Please review the TRICARE Operations Manual (TOM), Ch. 18, Sec. 3 and TRICARE Policy Manual (TPM), Ch. 1, Sec. 5.1 for complete details.

  • The full name of the beneficiary is required. 
  • The date and start and end times of each session is documented including the length of the session. 
  • The place of service (home, clinic/center, daycare (non-preschool), school, community, telemedicine).
  • Session participants’ name and relationship to the beneficiary must be documented. 
  • Include the name and credentials of the rendering ABA supervisor, assistant behavior analyst or Behavior Technician (BT), with a dated signature. 
  • The clinical status of the beneficiary is the specific, observable and measurable behavior displayed by the beneficiary at the beginning of treatment that indicates his/her readiness for learning, presence of antecedents to target behaviors and setting events. 
  • The narrative summary should indicate the primary areas targeted from the TP, describe the barriers to performance and be representative of the duration of time filed on of the claim.
  • ABA techniques such as Discrete Trial Training (DTT), chaining and prompting can be listed or marked in a check box. 
  • The narrative description should include how the beneficiary responded within the current session given the implementation of the TP goals. 
  • A narrative statement summarizing the beneficiary's degree of progress towards the treatment goals is needed.
  • Location (i.e. home, clinic, office, school, telehealth) missing (GPS coordinates do not meet this requirement)
    • Community locations not being authorized prior to rendering services
  • Rendering and billing providers do not match
  • Clinical status as defined by the Defense Health Agency (DHA) not included
  • Progress notes are illegible
  • Progress notes for 97151 missingare missing (TP alone does not meet this requirement, progress note required)
  • Misuse of 97155 for supervision/observation only
  • Protocol modification that occurred using 97155 not clearly defined in progress note
  • Narrative content missingis missing in the following areas (data alone does not meet this requirement):
    • Summary of session
    • Response to treatment
    • Summarizing patient’s degree of progress towards goal