NCAAS surveyed its members to identify and answer the most frequently asked questions about the new 2019 CPT I codes for adaptive behavior. Click here to view the FAQs. If we didn’t answer your question, you can ask your question on the NCAAS Facebook page.
November 14-16: NCAAS is attending the American Medical Association’s CPT and RBRVS 2019 Annual Symposium in Chicago. We have collected ABA providers’ most frequently asked questions and will post an FAQ resource by the end of the Symposium.
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Adaptive behavior codes for ABA to be “Contractor Priced.”
As anticipated, CMS did not value the adaptive behavior codes in its Final Rule. Instead, the codes are “contractor priced,” which means that providers will continue to negotiate rates with payers just as they do now.
NCAAS commends CMS for not establishing valuations for these codes prematurely as the growing autism prevalence rate and accompanying shortage of behavior analysts are but two elements that contribute to the unpredictability of the cost for providers to deliver top-quality ABA. Without understanding all of the elements that contribute to the cost of delivering ABA, the risk of a valuation that is not reflective of the actual cost to serve individuals diagnosed with autism spectrum disorder represented a significant concern as we awaited CMS’s NPRM. CMS’s decision to continue contractor pricing for the services covered by the adaptive behavior codes is good news to assure continued expanded access to ABA services, regardless of where families might live in the U.S.
Check back soon for more information following the release of the CPT® Assistant and CPT Changes.