Back to Top Skip to main content

New codes for applied behavior analysis services begin in New Year

Take Command of Your Health Take Command of Your Health

Recommended Content:

TRICARE Health Program

New procedure codes for providers of applied behavior analysis, or ABA, services under the TRICARE Comprehensive Autism Care Demonstration take effect Jan.1. 

“There should be little to no impact on beneficiaries since reimbursement rates and services provided to beneficiaries will remain unchanged,” said Navy Capt. Edward Simmer, Chief Clinical Officer, TRICARE Health Plan, and a psychiatrist. 

"The implementation of the new codes improves the provider claims process and brings the autism care demonstration more in line with the TRICARE basic benefit," he said.

The ACD covers ABA services for all eligible TRICARE beneficiaries diagnosed with autism spectrum disorder.  Behavior Analysis is based on the science of learning and behavior. The goal of ABA services is to increase behaviors that are helpful and decrease behaviors that are harmful or affect learning. ABA providers use ABA techniques to help children diagnosed with autism reach their maximum potential.  

Current procedural terminology, or CPT, codes are the U.S. standard for how health care professionals document and report medical, surgical, radiology, laboratory, anesthesiology, and evaluation and management services. CPT codes are used by all providers, payers, and facilities. 

The Category III CPT codes currently in use for ABA services under the ACD will be replaced by Category I CPT codes on Jan. 1, mandated by the American Medical Association, which is responsible for the creation and implementation of CPT codes. This change applies to all funding sources and providers, including TRICARE.

Many of the Category I codes mirror the Category III codes, Simmer noted. However, all of the new codes will be timed in 15-minute increments. The existing codes were either not timed or were in 30-minute increments.

Also, the Category I codes don't provide a separate code for supervision of paraprofessional ABA providers, who often provide much of the “hands-on” ABA services, Simmer said. Under the existing codes, which have more flexibility than the new Category I codes, supervision was reimbursed by TRICARE under a modified definition of a temporary Category III code. The new Category I codes no longer provide this flexibility, eliminating the mechanism to reimburse for supervision independently. 

In light of this, TRICARE has also removed the TRICARE-specific requirements for the supervision of paraprofessional ABA providers by ABA supervisors. Supervision will no longer be a separate reimbursable service. However, paraprofessionals still will be supervised. Simmer said TRICARE will rely on the certifying and licensing bodies for behavior analysts, which require supervision as a core requirement for certification.

"Providers will continue to bill for services based on the certification level of the provider rendering care," he said, adding that this is the same as the current reimbursement system. 

"The change to supervision will give providers more flexibility with providing and receiving supervision and may free more provider time for direct services to new beneficiaries, which is expected to improve access to care,” Simmer said. “Quality should not suffer as the minimum supervision requirements are set by the certification body to ensure high quality care is delivered."

Information sessions for providers are scheduled for Dec. 19 and Jan. 9. For ACD announcements and invitations to future meetings, providers can subscribe to GovDelivery. Information for the provider meetings are sent with the meeting invites or can be requested at DHA.ACD@mail.mil. Providers may also contact the managed care support contractor for their region. 

You also may be interested in...

Download Letter to Beneficiaries

Publication
6/24/2020

This message replaces guidance issued on March 31. It explains actions military pharmacies are taking to keep services and visits safe during the COVID-19 pandemic, and it outlines your pharmacy options as a TRICARE beneficiary.

Recommended Content:

Coronavirus | COVID Pharmacy Guidance | TRICARE Health Program

TRICARE Program Effectiveness

Congressional Testimony
6/9/2020

S. 1124 NDAA Conference Report for FY 1996; Sec. 717, As modified by S. 1356, NDAA Conference Report for FY 2016, Sec. 713

Recommended Content:

TRICARE Health Program

Communication to ABA Providers Regarding Continued Temporary Authorization to Utilize Telehealth for CPT Code 97156 During the COVID-19 National Emergency

Publication
6/3/2020

TRICARE is announcing the continuation of the temporary exception to policy regarding the use of synchronous telehealth (TH) capabilities (both audio and video) for Applied Behavior Analysis (ABA) Family Adaptive Behavior Treatment Guidance services specifically during this COVID-19 pandemic.

Recommended Content:

Autism Care Demonstration | Coronavirus | TRICARE Health Program

DHA increases access to telehealth during COVID-19 pandemic

Article
5/19/2020
Medical personnel sitting at desk talking into laptop monitor

Use of telehealth role increases to prevent COVID-19 spread

Recommended Content:

TRICARE Health Program | Coronavirus

TRICARE Improper Medical Claims Payments

Congressional Testimony
4/24/2020

S. 1790, SASC Report for FY 2020, 116-48, Pg. 213-214

Recommended Content:

TRICARE Health Program

Benefits Eligibility for 32 USC 502(f) Missions

Publication
4/14/2020

A chart outlining the various Benefits Eligibility for 32 USC 502(f) Missions

Recommended Content:

Coronavirus | TRICARE Health Program

TRICARE Coverage of Continuous Glucose Monitors

Congressional Testimony
4/9/2020

S. 1790, SASC Report for FY 2020, 116-48, Pg. 213

Recommended Content:

TRICARE Health Program

Decision Memorandum on TRICARE Implementation of the "Families First Coronavirus Response Act"

Publication
4/7/2020

The Families First Coronavirus Response Act, Public Law 116-127, Division F, Section 6006(a), limits TRICARE authority to impose copayment or other cost-sharing for novel coronavirus (COVID-19) testing and related provider visits that result in orders for or administration of Food and Drug Administration (FDA) approved, cleared, or authorized diagnostic products. In order for the Defense Health Agency (DHA) to implement, the Assistant Secretary of Defense for Health Affairs (ASD(HA)) must acknowledge the self-executing authority of the statute and direct the Director, DHA, or designee, to issue guidance implementing the statutory provisions.

Recommended Content:

TRICARE Health Program | Coronavirus

Possible changes at MTF pharmacies in response to COVID-19

Article
3/31/2020
A military pharmacist choosing medication from a shelf

Find out the latest pharmacy policies at MTFs

Recommended Content:

Coronavirus | Public Health | TRICARE Health Program

Tiered Telehealth Health Care Support for COVID-19

Publication
3/31/2020

This memorandum establishes guidance for the use of Telehealth (TH) Information Technology (IT) tools in support of the clinical care required for patients across the spectrum of COVID-19 illness

Recommended Content:

TRICARE Health Program | Public Health | Coronavirus

Pharmacy Guidance for Market MTFs

Publication
3/31/2020

Message to Pharmacy Beneficiaries regarding military pharmacy services during the COVID-19 pandemic.

Recommended Content:

Coronavirus | Pharmacy Division | TRICARE Health Program

Policy Exception for Telehealth Use for ABA during COVID-19 Pandemic

Publication
3/30/2020

Communication to ABA Providers Regarding Temporary Authorization to Utilize Telehealth for CPT Code 97156 During the COVID-19 National Emergency

Recommended Content:

Coronavirus | Autism Care Demonstration | TRICARE Health Program

Q & A: Policy Exception for Telehealth Use for ABA during COVID-19 Pandemic

Publication
3/30/2020

Question and Answer: TRICARE Autism Care Demonstration (ACD): Regarding Temporary Authorization to Utilize Telehealth for CPT Code 97156 during the COVID-19 National Emergency

Recommended Content:

Coronavirus | Autism Care Demonstration | TRICARE Health Program

Report on Requirement for Certain Former Members of the Armed Forces to Enroll in Medicare Part B to be Eligible for TFL; TRICARE Access Study; and Improving Health Care Choices for Severely Injured Service Members

Congressional Testimony
3/2/2020

H.R. 5515, NDAA Conference Report for FY 2019, 115-874, Sec. 734; H.R. 5515, HASC Report for FY 2019, 115-676 ,Pg. 132; S 2987, SASC Report for FY 2019, 115-262, Pg. 223

Recommended Content:

TRICARE Health Program

MHS Minute February 2020

Video
2/25/2020
MHS Minute February 2020

Thanks for tuning in to the MHS Minute! This month, we highlight a historical moment in #MilitaryHealth history, as Defense Health Agency (DHA) established the first four health care markets in the military medical enterprise. We also take a look at the Military Health System (MHS) response to Novel Coronavirus -- learn more about what Madigan Army Medical Center is doing to combat the threat of illness by going to mamc.health.mil.

Recommended Content:

MHS Transformation | TRICARE Health Program | Coronavirus
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 17

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.