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CPT 97155 | Adaptive Behavior Treatment With Protocol Modification

CPT code 97155 can be billed for adaptive behavior treatment administered by a physician or other qualified healthcare professional in 15-minute face-to-face interaction with the patient.

What Is CPT Code 97155?

CPT 97155 describes adaptive behavior treatment that involves modifying past protocol targets and incorporating changes in the context and environment to achieve desired behaviors in the patient.

The provider demonstrates the modified protocol to a technician and may provide simultaneous direction to the technician during the treatment.

This type of treatment is based on principles such as analyzing and altering contextual events and motivating factors, implementing stimulus consequence strategies and replacement behaviors, and monitoring outcomes.

It is often used to reduce repetitive and aberrant behaviors and improve communication and social functioning. 

It involves breaking down adaptive behavior skill tasks into small, measurable units that the patient practices until mastery is achieved.

Description

The CPT book describes CPT code 97155 as: “Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, every 15 minutes.”

Procedure

The provider modifies the past protocol targets and incorporates changes in the context and environment to achieve desired behaviors in the patient. Finally, he demonstrates the new or modified protocol to a technician.

For example, the provider will modify the past protocol targets and treatment services that the provider renders to a teenager who is with a foster family for the first time and is experiencing a regression of the behavioral targets related to the patient’s atypical sleeping patterns that were successfully met in a group home setting.

He does this to improve the patient’s sleeping patterns and prevent sleep deprivation.

Adaptive behavior treatment addresses the patient’s specific target problems and treatment goals as a provider define in previous assessments.

This treatment is based on principles including analysis and alteration of contextual events and motivating factors, stimulus consequence strategies and replacement behavior, and monitoring outcome metrics.

The goals of adaptive behavior treatment include the reduction of repetitive and aberrant behavior and improved communication and social functioning.

Adaptive behavior skill tasks are often broken down into small, measurable units, and the patient practices each skill repeatedly until the patient masters it.

How To Use CPT 97155

Do not report CPT code 97155 in conjunction with CPT 90785 to CPT 90899, CPT 92507, CPT 96105 to CPT 96171, or CPT 97129.

CPT 97155 is used when the treatment is administered by a physician or other qualified healthcare professional and involves face-to-face interaction with the patient for 15-minute intervals.

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