Billing, claims and reimbursement

ABA providers are considered outpatient specialty providers. Authorized ABA supervisors and ACSPs are allowed to bill for ABA services.

Claims processing

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

CPT codes for ABA

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).

  • CPT 97151 - Behavior identification assessment and treatment plan
  • CPT T1023 - PDDBI assessment/Outcome measures completed and submitted by BCBA/BCBA-D
  • CPT 97153 - Adaptive behavior treatment by protocol
  • CPT 97155 - Adaptive behavior treatment by protocol modification
  • CPT 97156 - Family adaptive behavior treatment guidance

Note: For telemedicine, the GT modifier must be used.

Learn more about the ABA Maximum Allowed Amounts

Did you know?

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.

Learn more