If you are using a MAC or Apple device to submit claims through the Provider Portal web application, you must use CHROME. Safari will cause errors in the web application submitting claims.

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Billing, claims and reimbursement for Applied Behavior Analysis (ABA)

ABA providers are considered outpatient specialty providers. Authorized ABA supervisors and Autism Care Corporate Service Providers (ACSP) are allowed to bill for ABA services.

View ABA Maximum Allowed Amounts

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Claims processing

All claims must be submitted electronically with Wisconsin Physicians Service (WPS) in order to receive payment for services. 98% of claims must be paid within 30 days and 100% within 90 days. 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.

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Important note for claims processing and recoupments:

Providers should include the start and stop times on the individual claim lines when submitting claims, even when billing for multiple services rendered by the same rendering provider on the same day. These sessions must be separated out, even when the CPT code is the same. When the times are not submitted on the individual lines, claims processing is delayed as additional research is required to confirm the correct start and stop times and corresponding charges.

CPT codes for ABA

In accordance with the TRICARE Operations Manual (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).

The ACD adopted new Category I CPT codes. Specifically, the ACD has adopted 97157, 97158, 99366, and 99368. New codes are eligible to be used beginning August 1, 2021 when prior authorized. Please note that revisions to existing authorizations is not permitted.

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  • CPT 97151 Behavior identification assessment and treatment plan
  • CPT T1023 PDDBI assessment/Outcome measures completed and submitted by BCBA/BCBA-D (for authorizations issued prior to August 1, 2021)
  • CPT 97153 Adaptive behavior treatment by protocol
  • CPT 97155 Adaptive behavior treatment by protocol modification
  • CPT 97156 Family adaptive behavior treatment guidance
  • CPT 97157 Multiple family group adaptive behavior treatment guidance
  • CPT 97158 Group adaptive behavior treatment by protocol modification
  • CPT 99366 Medical team conference, with patient
  • CPT 99368 Medical team conference, without patient