Accurate insurance billing for Applied Behavior Analysis (ABA) therapy is crucial for timely reimbursements and smooth revenue cycle management. Whether you are a solo ABA therapist or part of a large behavioral health practice, understanding how to navigate insurance billing can significantly improve your cash flow and reduce claim denials.
In this comprehensive guide, A2Z Billings explains how to bill insurance for ABA therapy, how to handle secondary insurance claims, and what to know about insurance reimbursement rates for ABA therapy.
Understanding ABA Therapy Insurance Billing
ABA therapy is a medically necessary service for individuals diagnosed with autism spectrum disorder (ASD) and related developmental conditions. Because of its clinical importance, most private and public insurance plans cover ABA services—but billing can be complex.
Insurance companies require detailed documentation, specific CPT codes, and adherence to payer guidelines. Common CPT codes for ABA therapy include:
- 97151 – Behavior Identification Assessment
- 97153 – Adaptive Behavior Treatment (by technician)
- 97155 – Adaptive Behavior Treatment with Protocol Modification
- 97156 – Family Adaptive Behavior Treatment Guidance
- 97158 – Group Adaptive Behavior Treatment
Step-by-Step Process: How to Bill Insurance for ABA Therapy
Billing ABA therapy requires a structured approach to ensure claims are clean, accurate, and supported by proper documentation. Below is a step-by-step process to help you manage ABA billing efficiently.
1. Verify Patient Insurance Coverage
Before initiating services, confirm the patient’s eligibility and benefits:
- Check if ABA therapy is covered under their plan.
- Verify pre-authorization or referral requirements.
- Identify any coverage limitations such as visit caps or age restrictions.
- Record deductibles, co-pays, and co-insurance amounts.
This step helps prevent claim denials due to coverage issues and sets clear expectations with families.
2. Obtain Prior Authorization
Most insurance companies require prior authorization for ABA services. This typically involves:
- Submitting a treatment plan prepared by a Board Certified Behavior Analyst (BCBA).
- Including diagnostic reports and medical necessity documentation.
- Specifying the number of therapy hours and duration.
Timely authorization ensures that services rendered are reimbursable.
3. Accurate Coding and Documentation
Using the correct CPT and ICD-10 codes is essential. Pair your CPT codes with the appropriate autism-related ICD-10 codes (e.g., F84.0 for Autistic Disorder).
Ensure documentation includes:
- Date and time of session
- Provider credentials
- Detailed therapy notes
- Session duration and activities performed
Accurate documentation not only supports reimbursement but also protects your practice during audits.
4. Submit Clean Claims
Once the services are rendered:
- File claims electronically via a clearinghouse or payer portal.
- Double-check for errors such as missing modifiers, wrong NPI, or incomplete patient info.
- Submit claims promptly to meet timely filing limits.
Pro Tip: Partnering with a professional billing company like A2Z Billings can help reduce claim rejections and speed up payment cycles.
5. Track Claims and Manage Denials
Monitor the claim status regularly. If a claim is denied:
- Review the Explanation of Benefits (EOB) to understand the denial reason.
- Correct the error and resubmit the claim promptly.
- Appeal if necessary with supporting documentation.
Efficient denial management ensures your practice doesn’t lose revenue due to avoidable errors.
How to Bill Secondary Insurance for ABA Services
Sometimes, patients have dual insurance coverage—a primary and a secondary plan. Understanding how to bill secondary insurance for ABA services is crucial to maximize reimbursement.
Step 1: Bill the Primary Insurance First
Always submit the claim to the primary insurance carrier first. Wait for the EOB to be processed.
Step 2: Obtain the Primary EOB
Once the primary payer processes the claim, you’ll receive an EOB detailing the amount paid, adjustments, and patient responsibility.
Step 3: Submit to Secondary Insurance
Include the primary EOB and resubmit the claim to the secondary insurance. The secondary payer may cover:
- Remaining patient balance (deductibles, co-pays, co-insurance)
- Any amount not covered by the primary insurance
This ensures the patient’s financial responsibility is minimized and your practice receives maximum reimbursement.
When to Bill Secondary Insurance for ABA Services
You should bill secondary insurance after receiving the primary EOB. Common scenarios include:
- The primary plan denies part of the claim and secondary may cover it.
- The primary plan covers only a portion, and secondary picks up the rest.
- When coordination of benefits (COB) rules specify secondary billing.
It’s important to not bill both simultaneously, as this can lead to claim rejections and payment delays.
Many ABA practices use automated billing systems or rely on expert billing partners like A2Z Billings to manage this process accurately.
Insurance Reimbursement Rates for ABA Therapy
Insurance reimbursement rates for ABA therapy vary widely depending on:
- State regulations
- Payer contracts
- Provider credentials
- Type of service (assessment vs. treatment)
Typical national averages for ABA reimbursement (per hour) can range:
- $50–$80 per hour for technician services (97153)
- $90–$120 per hour for BCBA-led sessions (97155)
- $150+ per hour for assessments (97151)
However, these are only benchmarks. Providers should negotiate contracts carefully and review fee schedules to ensure sustainable revenue.
A2Z Billings helps ABA practices analyze payer contracts, identify underpayments, and optimize collections.
Common Challenges in ABA Insurance Billing
ABA billing involves complexities that can lead to revenue loss if not handled properly:
- Missing Authorizations: Leads to claim denials for medically unnecessary services.
- Incorrect CPT/ICD Codes: Triggers rejections or underpayments.
- Late Claim Submission: Results in missed timely filing deadlines.
- Poor Documentation: Increases audit risks and payment delays.
- Lack of Follow-Up: Causes unresolved denials and aged A/R.
Partnering with a specialized billing team ensures these issues are minimized, allowing providers to focus on delivering quality care.
Why Outsource ABA Therapy Billing to A2Z Billings
At A2Z Billings, we specialize in ABA therapy medical billing, offering end-to-end solutions including:
- Insurance eligibility verification
- Prior authorization management
- Accurate coding & clean claim submission
- Denial management & appeals
- Secondary insurance coordination
- Revenue cycle reporting & analytics
Our team understands the nuances of ABA therapy billing, ensuring your practice receives maximum reimbursement with minimal delays.
Visit A2Z Billings to learn how we can help your practice improve cash flow and reduce administrative burdens.
Key Takeaways
- Verify coverage & authorization before starting ABA services.
- Use accurate CPT & ICD-10 codes for clean claims.
- Bill primary first, then secondary insurance with the EOB.
- Understand your reimbursement rates and negotiate contracts smartly.
- Consider outsourcing to experts like A2Z Billings for better efficiency and revenue outcomes.
Final Thoughts
Billing insurance for ABA therapy involves a mix of clinical documentation, coding accuracy, and payer policy knowledge. By following best practices and leveraging expert billing support, ABA providers can ensure steady cash flow and focus on their core mission improving patients’ lives.
Partner with A2Z Billings today to simplify your ABA insurance billing process and boost your revenue cycle performance.
Frequently Asked Questions (FAQs)
- What CPT codes are commonly used for ABA therapy billing?
CPT codes like 97151 (assessment), 97153 (technician services), and 97155 (BCBA modification) are commonly used for ABA billing. - How long does it take to get paid after submitting an ABA claim?
Typically, insurance companies process clean claims within 14–30 days, depending on the payer. - Can I bill both primary and secondary insurance simultaneously for ABA services?
No. You must bill the primary insurance first, receive the EOB, and then bill secondary insurance. - What are the common reasons for ABA claim denials?
Missing authorizations, incorrect codes, lack of documentation, and late submissions are among the most common reasons. - How can A2Z Billings help with ABA therapy insurance billing?
A2Z Billings offers comprehensive ABA billing services, including verification, authorizations, claims submission, denial management, and secondary billing to maximize reimbursements.