ACD billing updates

08/01/2021

ACD CPT code modifications made

Changes include:

• HCPCS T1023 will no longer be issued for authorizations approved on or after August 1, 2021
• The contractor may authorize one additional unit of indirect CPT code 97151 per measure for providers that complete the Vineland, the SRS, and the PSI/SIPA, when prior authorized
• CPT 97155 can be delegated to an assistant behavior analyst, however it must be completed at least once per month by the ABA supervisor
• CPT 97156 may be conducted via telehealth only after the first six-month authorization period per authorized provider

04/15/2019

ACD CPT code modifications made

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)

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.

01/01/2019

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.

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