CommercialBilling CodesHigh impact
Applied Behavioral Analysis (ABA) Coding Policy
Blue Cross & Blue Shield of Mississippi·MS · Psychiatry, Pediatrics, Family Medicine·Coding
Effective date
Jan 1, 2015
We identified it
Jun 20, 2026
Summary
BCBS Mississippi has established comprehensive coding and billing guidelines for Applied Behavioral Analysis (ABA) services for Autism Spectrum Disorder treatment. The policy defines specific CPT codes, time limitations, provider qualifications, and billing restrictions that must be followed for ABA claims to be processed and reimbursed.
Action Required
Immediately: Billing teams handling BCBS Mississippi ABA claims must update billing systems to enforce time-based limitations (15-minute increments for dates after 1/1/2019), restrict CPT 97151 to once every 6 months, limit follow-up assessments (97152, 0362T) to 6 hours every 6 months, and ensure only BCBA/BCBA-D providers can file claims (not assistants/technicians). Update encounter forms to reflect protocol modification limits (97155: 2 hours per 10 hours of therapy; 0373T: 3 hours every 2 months). Exceeding these limits will result in claim denials.