ABA Therapy Billing Guide for Successful Claims Approval

There is a way to create a clear, reliable Applied Behavior Analysis (ABA) therapy billing process that doesn’t feel overwhelming and makes it easy to comply with multiple payor requirements.

What is ABA therapy billing?

ABA therapy billing is the process of getting paid for the services your clinic provides.

It covers items such as session claims and prior authorizations, and it all starts with accurate documentation. This includes:

• Session details: Who provided the therapy, what interventions were delivered, and how long the session lasted.
• Progress tracking: Recording the outcomes and goals for each individual client.
• Billing and claims: Submitting invoices to insurance payors, tracking payments, and managing reauthorizations.

Why is therapy billing so tricky?

Therapy billing can feel hard to grasp at first because there can be a lot to cover, like:

• Multiple payors: Different insurance plans may have different rules, coverage limits, and documentation requirements. For example, one payor might cover 20 sessions per month, whereas another might need prior authorization for every session.
• Detailed documents: If your session notes are incomplete or illegible, claims could be delayed or denied.
• Compliance requirements: Standardized documentation is useful for helping regulators and payors prevent fraud and record payments accurately.
• Individualized care: Each client’s therapy plan is unique, so every claim needs to reflect their specific interventions, goals, and outcomes.

ABA billing involves more than just invoicing. You need precise record-keeping, coordination across payors, and constant compliance checks. But it’s worth getting right so your clinic gets paid on time and avoids audit risks.

Key ABA billing codes and requirements

ABA therapy billing relies on specific Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes that define the services you provide.

Using the right codes helps your claims get processed correctly and reduces the chance of denials.

Some of the main categories include:

• Behavioral analysis codes (e.g., 97151, 97152, 97153): These codes cover services like assessments, treatment planning, and direct therapy sessions, including individual or group sessions.
• Caregiver guidance and training codes (e.g., 97156, 97157): These are used when Board Certified Behavior Analysts (BCBA) provide treatment guidance to family members or caregivers.
• Direct treatment and protocol modification codes (e.g., 97155, 97158): Used when BCBAs provide direct treatment to clients while modifying protocols, either individually or in group settings.
• Adaptive behavior services (e.g., temporary Category III codes, 0362T or 0373T, for emerging ABA services): Used for assessment and direct treatment of individuals with challenging behaviors.

To support these claims, you’ll also need to include detailed and accurate documentation, including:

• Session notes: Record the date, duration, staff involved, interventions delivered, and the individual’s response.
• Progress reports: Summarize how the individual is meeting goals and any changes in their treatment plan.
• Outcome data: Include trial-by-trial data or skill acquisition metrics that show measurable progress.
• Authorization and prior approval records: Keep copies of your insurance approvals, limits, and reauthorization requests.

It is also important to check all payor requirements to determine what should be included in your documentation.

Common billing mistakes and how to avoid them

Even small mistakes in ABA therapy billing can lead to claim denials or payment delays.

But with so many details to include, clinics could run into a few recurring issues:

• Insufficient documentation: Vague or incomplete session notes can trigger denials. Additionally, session note requirements may differ by payor.
• Mismatched billing codes: Using the wrong CPT or HCPCS code can also lead to rejected claims.
• Missed progress updates: Skipping progress reports or not showing measurable outcomes can prevent reauthorizations.
• Late or missing prior authorizations: Some payors need pre-approval for certain services.
• Overlapping or duplicate claims: Billing two services for the same time period can trigger audits.

Note that concurrent billing is sometimes appropriate under certain circumstances (such as codes 97155 with 97153 when a BCBA directs a technician or supervision is provided), as long as permitted by the payor.

By following clear documentation rules, checking codes, and keeping progress and authorizations up to date, you can reduce denials, get paid faster, and keep billing running smoothly.

Best practices for ABA billing

Avoiding ABA billing mistakes starts with building strong habits across your clinic.

Here are a few ways to maintain a smooth workflow:

• Take accurate session notes: Record every detail (e.g., date, duration, interventions, individual client response, and staff involved). Clear notes reduce claim denials and improve clinical oversight.
• Make timely claims submissions: Submit claims as soon as possible after sessions. Faster submissions can prevent delays and reduce the risk of forgetting details.
• Regularly track your progress: Link session data to measurable treatment goals and generate progress reports consistently. This shows effectiveness to payors and supports reauthorizations.
• Internally audit for quality control: Regularly review your session notes, billing codes, and claims to catch errors early. These internal audits can help your team identify patterns, prevent mistakes, and maintain compliance.

Following these practices keeps your billing accurate, compliant, and efficient, so your staff can focus more on therapy and less on paperwork.

Why billing efficiency matters for ABA clinics

Beyond ticking the boxes to take care of paperwork, having strong billing systems in place can directly impact your clinic’s ability to grow and provide quality care.

When your billing workflow is smooth:

• Cash flow stays steady: Claims are processed faster, reimbursements arrive on time, and your clinic can plan for staffing and resources without surprises.
• Staff workload is manageable: Clear processes can reduce time spent fixing errors, following up on denials, or re-entering claims.
• Client care improves: When staff aren’t bogged down with billing issues, you can dedicate more attention to your clients’ progress and session quality.
• Growth becomes more manageable: Efficient billing practices help your clinic expand to more clients or locations without administrative bottlenecks.

Simplify ABA therapy billing with Passage Health

Passage Health makes ABA billing faster, easier, and more reliable by putting all your tools in one platform, including:

• Real-time session notes and data collection: Clinicians can record therapy sessions on the mobile app as they happen to take down accurate documentation that supports claims.
• Automated coding rules: Set and automate billing claim coding rules across different payors and event types.
• Integrated reporting: Customizable reports let you track your approvals, denials, and billing trends, giving your team a clear view of revenue and workflow blockers.
• Connected documentation tools: Link session notes, codes, and reports so your team avoids mismatches and delays.

Passage Health also offers a 4-week training program/“billing bootcamp” for customers, where you can learn the fundamentals of ABA billing and RCM.

Book a demo to see how Passage Health can help your clinic deliver high-quality ABA services while keeping billing streamlined and accurate.

Frequently asked questions

What happens if documentation doesn’t match billing codes?

If documentation doesn’t match billing codes, claims could be denied or delayed, and repeated mismatches could trigger audits, which can slow cash flow and create extra work.

How often should a clinic submit ABA claims?

Regular claims submissions (whether weekly, biweekly, or on another consistent schedule) can help your clinic maintain steady cash flow and reduce the risk of lost or forgotten sessions.

What documentation do insurance companies typically request for ABA services?

Insurance companies usually require session notes, progress reports, treatment plans, and outcome data showing measurable client progress.

Can ABA session notes support billing claims?

Yes, if your notes clearly capture services provided, time, and outcomes, they can support claims submissions.

How can clinics track billing denials and resubmit successfully?

Use a system like Passage Health to log denials, flag errors, and correct and resubmit claims quickly.

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References

ABA Coding Coalition. (n.d.). ABA CPT codes. Retrieved from https://abacodes.org/codes/

American Medical Association. (n.d.). CPT overview and code approval. Retrieved from https://www.ama-assn.org/practice-management/cpt

Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. (effective January 1, 2022). Retrieved from https://www.bacb.com/wp-content/uploads/2022/01/Ethics-Code-for-Behavior-Analysts-240830-a.pdf

Centers for Medicare & Medicaid Services. (n.d.). Complying with medical record documentation requirements. U.S. Department of Health and Human Services. Retrieved from https://www.cms.gov/files/mln909160-complying-with-medical-record-documentation-requirements.pdf

Centers for Medicare & Medicaid Services. (n.d.). Healthcare Common Procedure Coding System (HCPCS). U.S. Department of Health and Human Services. Retrieved from https://www.cms.gov/medicare/coding-billing/healthcare-common-procedure-system

Woolhandler, S., & Himmelstein, D. U. (2014). Administrative work consumes one-sixth of U.S. physicians' working hours and lowers their career satisfaction. International Journal of Social Determinants of Health and Health Services, 44(4), 635-642. Retrieved from https://journals.sagepub.com/doi/10.2190/HS.44.4.a