How To Use CPT Code 97153

CPT 97153 refers to adaptive behavior treatment administered by a technician under the supervision of a physician or other qualified healthcare professional, targeting conditions such as developmental disabilities. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 97153.

1. What is CPT 97153?

CPT 97153 is a medical billing code used to describe adaptive behavior treatment services provided by a technician under the direction of a physician or other qualified healthcare professional. This treatment targets conditions such as developmental disabilities associated with adaptive or maladaptive behaviors, such as impaired social skills and communication. The code is reported for each 15 minutes that a technician performs this service face-to-face with one patient.

2. 97153 CPT code description

The official description of CPT code 97153 is: “Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes.”

3. Procedure

The 97153 procedure involves the following steps:

1. A physician or other qualified healthcare professional establishes a treatment protocol for the patient’s specific target problems and goals.
2. The technician, under the guidance of the physician or other qualified healthcare professional, administers adaptive behavior treatment face-to-face with the patient according to the established protocol.
3. Treatment is based on principles such as analysis and alteration of contextual events and motivating factors, stimulus consequence strategies, replacement behavior, and monitoring of outcome metrics.
4. Adaptive behavior skill tasks are broken down into small, measurable units, and the patient practices each skill repeatedly until they master it.
5. The treatment may take place in multiple sites and social settings, depending on the patient’s needs and goals.

4. Qualifying circumstances

Patients eligible to receive CPT code 97153 services are those diagnosed with developmental disabilities associated with adaptive or maladaptive behaviors, such as impaired social skills and communication. These patients must have a treatment protocol established by a physician or other qualified healthcare professional, and the treatment must be administered by a technician under the supervision of the physician or other qualified healthcare professional.

5. When to use CPT code 97153

It is appropriate to bill the 97153 CPT code when a technician, under the direction of a physician or other qualified healthcare professional, administers adaptive behavior treatment face-to-face with one patient for each 15-minute increment. This code should be used for patients with developmental disabilities associated with adaptive or maladaptive behaviors, such as impaired social skills and communication, and when the treatment follows a previously established protocol.

6. Documentation requirements

To support a claim for CPT 97153, the following information should be documented:

• Patient’s diagnosis and specific target problems and goals
• Treatment protocol established by the physician or other qualified healthcare professional
• Technician’s qualifications and supervision by the physician or other qualified healthcare professional
• Duration of the treatment session, including start and end times
• Location(s) where the treatment took place
• Progress notes detailing the patient’s response to treatment and any modifications made to the treatment protocol

7. Billing guidelines

When billing for CPT code 97153, keep in mind the following guidelines and rules:

• Report the code for each 15-minute increment that the technician performs the service face-to-face with one patient.
• Do not report 97153 in conjunction with 90785-90899, 92507, 96105-96171, or 97129.
• Ensure that the technician is appropriately supervised by a physician or other qualified healthcare professional during the treatment session.
• Document all required information to support the claim, as outlined in the documentation requirements section.

8. Historical information

CPT 97153 was added to the Current Procedural Terminology system on January 1, 2019. There have been no updates to the code since its addition.

9. Similar codes to CPT 97153

Five similar codes to CPT 97153 and how they differ are:

• CPT 97151: Involves assessment and reassessment of adaptive behavior by a physician or other qualified healthcare professional, rather than treatment by a technician.
• CPT 97152: Focuses on adaptive behavior treatment provided by a physician or other qualified healthcare professional, rather than a technician.
• CPT 97154: Involves group adaptive behavior treatment, with two or more patients receiving treatment simultaneously.
• CPT 97155: Refers to adaptive behavior treatment with protocol modification, requiring the physician or other qualified healthcare professional to be directly involved in the treatment session.
• CPT 97156: Covers family adaptive behavior treatment guidance, where the physician or other qualified healthcare professional provides guidance to the patient’s family members.

10. Examples

Here are 10 detailed examples of CPT code 97153 procedures:

1. A technician provides adaptive behavior treatment to a child with autism, focusing on improving communication skills, for a 45-minute session.
2. A patient with a developmental disability receives adaptive behavior treatment from a technician to reduce repetitive behaviors, with the session lasting 30 minutes.
3. A technician works with a patient with impaired social skills for 60 minutes, following a treatment protocol designed to improve the patient’s ability to interact with others.
4. A patient with a developmental disability receives a 15-minute adaptive behavior treatment session from a technician, focusing on increasing independence in daily living skills.
5. A technician provides a 30-minute adaptive behavior treatment session to a patient with a developmental disability, targeting the improvement of problem-solving skills.
6. A patient with a developmental disability and maladaptive behaviors receives a 45-minute adaptive behavior treatment session from a technician, focusing on reducing aggressive behaviors.
7. A technician works with a patient with a developmental disability for 60 minutes, providing adaptive behavior treatment to improve the patient’s ability to follow instructions and complete tasks.
8. A patient with a developmental disability receives a 15-minute adaptive behavior treatment session from a technician, focusing on increasing the patient’s ability to cope with frustration and stress.
9. A technician provides a 30-minute adaptive behavior treatment session to a patient with a developmental disability, targeting the improvement of the patient’s ability to engage in appropriate play and leisure activities.
10. A patient with a developmental disability and impaired communication skills receives a 45-minute adaptive behavior treatment session from a technician, focusing on improving the patient’s ability to express their needs and wants effectively.