Welcome TRICARE East providers

ACD CPT code changes effective January 1, 2019

Changes include:

• Update Category III CPT codes to Category I CPT codes
• Clarify that new authorizations are not required for this change
• Require use of new CPT codes for claim payment for dates of service on or after 1/1/2019
• Confirms continued exclusion of concurrent billing of ACD
• Clarify reimbursement rate processes for the new Category I codes
• Clarify requirements for session notes for certain treatment plan codes

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:

• Certain codes that were previously untimed, are now timed
• Codes were converted from 30 minute increments to 15 minute increments
• There is no longer a billable code for supervision. The Defense Health Agency (DHA) will rely on the supervision requirements of the credentialing bodies, but supervision is no longer being paid under the ACD

• TRICARE ACD Category I CPT Code Changes QAs
• TRICARE ACD Provider Information Meeting 2019 Category I CPT Codes
• TRICARE ACD Adaptive Behavior Service Category III to I CPT Crosswalk
• 2019 ABA reimbursement rates