How To Use CPT Code 97154

CPT 97154 describes the administration of group adaptive behavior treatment by a technician under the direction of a physician or other qualified healthcare professional. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 97154?

CPT 97154 can be used to describe the administration of group adaptive behavior treatment by a technician under the supervision of a physician or other qualified healthcare professional. This code is used when the technician provides face-to-face treatment to two or more patients, targeting conditions such as developmental disabilities associated with adaptive or maladaptive behaviors.

2. Official Description

The official description of CPT code 97154 is: ‘Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with two or more patients, each 15 minutes.’

3. Procedure

1. A physician or qualified healthcare professional determines the need for group adaptive behavior treatment for patients with developmental disabilities.
2. A treatment protocol is established, outlining the specific target problems and treatment goals for each patient.
3. A technician, under the direction of the physician or qualified healthcare professional, administers the treatment to a group of two or more patients.
4. The treatment is based on principles such as analysis and alteration of contextual events, stimulus consequence strategies, replacement behavior, and monitoring of outcome metrics.
5. The technician guides the patients through adaptive behavior skill tasks, breaking them down into small, measurable units, and providing repeated practice until mastery is achieved.
6. The treatment may take place in multiple sites and social settings, as determined by the overall treatment protocol.

4. Qualifying circumstances

CPT 97154 is appropriate for patients with developmental disabilities who require group adaptive behavior treatment. The treatment is administered by a technician under the direction of a physician or other qualified healthcare professional. The technician follows an established treatment protocol, targeting specific problems and goals identified in previous assessments.

5. When to use CPT code 97154

CPT code 97154 should be used when a technician administers group adaptive behavior treatment to two or more patients, face-to-face, for each 15-minute session. This code should not be reported if the group consists of more than eight patients. Additionally, CPT code 97154 should not be reported in conjunction with codes 90785-90899, 92508, 96105-96171, or 97150.

6. Documentation requirements

To support a claim for CPT 97154, the following documentation is required:

• Identification of patients receiving group adaptive behavior treatment
• Documentation of the treatment protocol and specific target problems and goals for each patient
• Date, start and end time of each 15-minute session
• Details of the treatment provided during each session, including the adaptive behavior skill tasks addressed
• Progress made by each patient and any adjustments to the treatment plan
• Signature of the supervising physician or qualified healthcare professional

7. Billing guidelines

When billing for CPT 97154, ensure that the treatment is administered by a technician under the direction of a physician or other qualified healthcare professional. The session should be face-to-face with two or more patients, lasting 15 minutes for each patient. Do not report CPT 97154 if the group consists of more than eight patients. Additionally, do not report CPT 97154 in conjunction with codes 90785-90899, 92508, 96105-96171, or 97150.

8. Historical information

CPT 97154 was added to the Current Procedural Terminology system on January 1, 2019. There have been no updates to the code since its addition.

9. Examples

1. A technician, under the direction of a physician, providing group adaptive behavior treatment to two patients with developmental disabilities, targeting social skills and communication, during a 15-minute session.
2. A qualified healthcare professional supervising a technician who administers group adaptive behavior treatment to three patients, focusing on reducing repetitive and aberrant behavior, in a 15-minute session.
3. A technician, under the direction of a physician, guiding a group of four patients through adaptive behavior skill tasks to improve their social functioning, during a 15-minute session.
4. A physician overseeing a technician who provides group adaptive behavior treatment to five patients, addressing impaired social skills and communication, in a 15-minute session.
5. A qualified healthcare professional directing a technician who administers group adaptive behavior treatment to six patients, targeting maladaptive behaviors, during a 15-minute session.
6. A technician, under the supervision of a physician, guiding a group of seven patients through adaptive behavior skill tasks to improve their communication, during a 15-minute session.
7. A physician overseeing a technician who provides group adaptive behavior treatment to eight patients, focusing on reducing repetitive behaviors, in a 15-minute session.
8. A qualified healthcare professional directing a technician who administers group adaptive behavior treatment to two patients, addressing impaired social skills, during a 15-minute session.
9. A technician, under the supervision of a physician, guiding a group of three patients through adaptive behavior skill tasks to improve their communication, during a 15-minute session.