Simplify ABA Billing and Strengthen Your Practice's Revenue Cycle
Providers of ABA therapy need accurate coding, timely claim submission, and effective insurance follow-up to maintain stable practices. Wisconsin Medical Billing specializes in ABA therapy billing and related services, including credentialing, authorization follow-ups, and other essential revenue cycle operations. Our ABA billing experts help practices reduce administrative burdens associated with submitting and following up on claims to ensure consistent delivery of individualized behavioral services.
Keep Your ABA Therapy Practice Financially Organized
96% Clean Claim Submission Rate
- Reduced AR Days by Up to 30%
- Higher First-Pass Claim Acceptance
- Faster Denial Resolution
Turn ABA Billing Challenges into More
Predictable Revenue
Submit Accurate Claims from the Start
ABA claims may be delayed for reasons such as procedure code mistakes, missing information on the claim, invalid modifiers, eligibility and/or payer specific billing issues, and other reasons. Our billing team examines claim information for submission and necessary documents and payer requirements for correctness to highlight any preventable errors and to ensure claims are processed consistently.
Resolve Denials Before They Disrupt Cash Flow
A denied ABA claim could mean additional paperwork, editing in the coding, go-through of authorization or the payer to get reimbursement. We identify the reason for the denial, decide what to do next and follow through so your clinic gets paid for the work done.
Reduce Time Spent on Insurance Follow-Up
Insurance follow-ups, authorizations, denials, or balances are time-consuming tasks that take your administrative and clinical staff away from caring for your patients. Your staff will have more time to support and manage day to day practice operations and we will take care of routine payer follow ups and claim status enquiries.
Keep Accounts Receivable Under Control
Unpaid balances might create cash flow problems especially when there are many sessions and/or authorizations pending. Our A/R staff works to follow up on unpaid amounts and decide the next proper action to be sure claims are resubmitted appropriately.
Make ABA Therapy Billing Easier to Manage
You don't have to choose between maintaining payer information and helping your clinical team. How Wisconsin Medical Billing can help your ABA practice: Help your practice get the most out of its billing process by automating key revenue cycle operations such as billing submission/posting, denials and A/R follow-up. Our billing support can be tailored to your practice's specific workflows, payer mix, and administrative support needs to help manage the financial operations side of your practice.
ABA Therapy Coding Requires More Than Selecting
a Procedure Code
Applied Behavior Analysis services can involve assessments, treatment, protocol modification, caregiver guidance, and group intervention services among others. The CPT code used for billing largely depends on the service rendered, who rendered it, supporting documentation, time requirements where applicable, and payer-specific billing requirements. Our ABA medical coding support helps practices review commonly used codes, including:
| ABA Therapy Service | Common CPT Codes |
| Behavior identification assessment | 97151 |
| Behavior identification supporting assessment | 97152 |
| Adaptive behavior treatment by protocol | 97153 |
| Group adaptive behavior treatment by protocol | 97154 |
| Adaptive behavior treatment with protocol modification | 97155 |
| Family adaptive behavior treatment guidance | 97156 |
| Multiple-family group adaptive behavior guidance | 97157 |
| Group adaptive behavior treatment with protocol modification | 97158 |
| Certain adaptive behavior treatment assessments | 0362T, when applicable |
The correct code should be consistent with the CPT criteria for that code and the procedure conducted. A claim’s submission can be affected by qualifying criteria for a provider, supporting documentation, authorization limits, units, modifiers, and payer-specific laws. We help review these details to reduce avoidable coding errors and support accurate reimbursement.
ICD-10-CM Coding Establishes the Clinical
Reason for ABA Care
Diagnosis coding helps inform the clinical basis for services provided and helps support the medical necessity of billed services. The diagnosis must reflect the documentation in the record by the treating provider and the coverage requirements of the billing payer. For ABA practices, the following diagnosis codes may be relevant depending on the individual patient's documented condition:
| ICD-10-CM Code | Condition |
| F84.0 | Autism spectrum disorder |
| F84.9 | Pervasive developmental disorder, unspecified |
| F90.9 | Attention-deficit/hyperactivity disorder, unspecified type |
| R62.50 | Unspecified lack of expected normal physiological development |
| F88 | Other disorders of psychological development |
The following are example diagnosis codes and are not intended as a complete list of indications for ABA care. The code should be used in conjunction with the patient’s clinical record and the ICD-10-CM official coding rules. Coverage, medical necessity and authorization criteria vary per payer and plan.
Billing Solutions for Different ABA Practice Models
Our ABA therapy billing services can support a range of providers and organizations, including:
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Independent BCBA Practices
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ABA Therapy Clinics
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Pediatric Behavioral Health Practices
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Group ABA Practices
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Group ABA Practices
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Autism Treatment Centers
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Home-Based ABA Providers
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Home-Based ABA Providers
Whether you operate an independent practice or a growing ABA organization, our services can be adapted to your claim volume, payer mix, and administrative workflow.
Services That Support Your Entire ABA Revenue Cycle
ABA Therapy Medical Billing
We provide fundamental billing functions including charge entry submission, payment posting, insurance follow-up and A/R administration. Our staff helps streamline billing procedures to assist your clinic maintain track of submitted claims and expected payments.
ABA Therapy Medical Coding
We focus our coding support on proper billing using CPT/ICD-10-CM codes for services rendered. Our staff review documentation, units, modifiers and payer requirements to assist in identification and reduction of common coding errors which can lead to increased rejection, denial or delayed reimbursement.
ABA Provider Credentialing and Enrollment
We’ll certify your insurance and get you enrolled with your payers. Successful enrolment files can assist a provider join payer networks, stay in the databases and support your invoicing under the correct provider credentials.
What Makes Our ABA Billing Support Different?
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What Makes Our ABA Billing Support Different?
ABA billing involves specific service codes, documentation expectations, authorization limits, and payer rules. Our approach considers the operational details of ABA practices instead of treating every claim like a standard medical office claim.
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Careful Claim Review
We carefully review claim detail for potential coding, eligibility, documentation, and billing issues prior to submission to flag avoidable errors that could increase your practice's risk of claim rejections and delays.
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Consistent Denial Follow-Up
When we deny any claims, we assess the claim denial reason, find areas to improve on, and ensure proper follow-up is in place to get the claim paid. We assist in identifying common denial follow-up areas on your claims.
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Support That Adapts to Practice Growth
As you increase clinicians, locations, and insurance plans, our billing operations can help scale to meet your growing requirements without overburdening your internal billing operations with additional administrative workload.
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More Time for Clinical Priorities
By delegating billing operations to our team, your administrative and clinical teams can dedicate more time to supporting practice operations and focus on providing appropriate documentation and treatment to patients. We help reduce avoidable billing operations while maintaining consistent financial operations for your practice.
Let Us Handle the Billing While You Focus on ABA Care
From medical coding, to claim submission, denial follow-ups, and A/R management, Wisconsin Medical Billing helps ABA therapy practices handle the financial operations surrounding behavioral services. Our team works to ensure billing operations are well-organized, identify potential avoidable errors affecting claims, and ensure appropriate reimbursement per payer requirements.
Frequently Asked Questions About
ABA Therapy Billing
ABA therapy medical billing services may involve authorization follow ups, charge input, coding of CPT and ICD-10-CM codes, claim submission and follow up, posting of payments, denial management, A/R follow up, reporting, along with insurance eligibility verification. These services can be customized to your practice’s coding, authorization and claims submission needs.
Common CPT codes are: 97151 behavior identification assessment, 97153 adaptive behavior therapy by protocol, 97155 adaptive behavior treatment by protocol modification, 97156 family adaptive behavior guidance. Other codes can be used for group services and career advising, and support assessments. Code selection is based on the service performed and applicable CPT and payer standards.
Yes. Wisconsin Medical Billing offers revenue cycle support to healthcare practices including ABA therapy billing, code review, claim filing, denial follow-ups, A/R administration, and provider certification. We can personalize our services to meet your practice’s billing and operating needs.
Our billing assistance may help you with investigating denied claims, reviewing pertinent authorization information, identifying anomalies in documentation and/or code, and following up as needed. Authorization permission does not guarantee payment. Claims must meet coverage, documentation and payer requirements.
A strong billing process can help you identify problems with eligibility, authorization, code selection, modifiers, units, provider enrolment and session documentation before the claim is submitted. Timely evaluation and appropriate corrections or appeal can help practices pursue eligible reimbursement and handle repeated concerns if denials occur.