ACD CPT code modifications made April 15, 2019

Changes include:

• CPT 97151 must be used within 14 calendar days of the first date of service for CPT 97151, and is a use-or-lose concept
• If CPT 97151 is billed with a date of service outside 14 calendar days of the first date of service, the claim will be denied
• An exception to the 14-day rule can be granted in situations out of the provider’s control
• If the delay was the result of circumstances outside of the provider's control, the provider may follow the appeals process for exception consideration
  • Network providers must submit a signed Appointment of representation form with the appeal

  *For guidance on the appeals process, refer to the TRICARE claims information section of the provider handbook.

Concurrent billing is excluded for all ACD Category I CPT codes except when the family and the beneficiary are receiving separate services and the beneficiary is not present in the family session. For example, CPT 97153 and 97156 could be billed concurrently if services were being provided to the beneficiary and family in two separate locations. Documentation must indicate two separate rendering providers and locations for the services. If CPT 97153 and 97155 are billed concurrently, the higher rate will be paid and the other will be denied.