MedicaidBilling CodesMedium impact
Clarification for Provider Bulletin Volume 41 Number 32, dated December 28, 2018
Missouri Medicaid (MO HealthNet)·MO · Psychiatry·Provider Notice
Effective date
Jan 30, 2019
We identified it
Jun 20, 2026
Summary
Policy clarifies daily unit limits for Applied Behavior Analysis (ABA) billing codes, where each unit equals 15 minutes. For example, CPT 97151 has a maximum of 8 units (2 hours) per day, and CPT 97152 has a maximum of 32 units (8 hours) per day.
Action Required
Immediately: Billing team must update system edits to enforce daily unit limits for ABA codes - CPT 97151 maximum 8 units per day, CPT 97152 maximum 32 units per day. Update billing software to prevent submission of claims exceeding these limits. Train staff that each unit equals 15 minutes of service.