ABA CPT Codes 2026: All 10 Billing Codes + 2027 Changes

Billing codes are the connective tissue between your clinical work and your revenue. Get them right, and insurance payments flow. Get them wrong, and you're dealing with denied claims, delayed reimbursements, and hours lost to appeals that could have been avoided.

This guide covers every active ABA CPT code for 2026, the modifiers that make or break claims, the unit billing rules payers actually enforce, the concurrent-billing restrictions that spread across state Medicaid programs this year, and what CMS's proposed 2027 fee schedule already tells us about the coming code overhaul. Whether you handle billing in-house or work with an ABA revenue cycle management partner, understanding these codes is foundational to protecting your practice's cash flow.

The short answer. ABA services bill under 10 active CPT codes in 2026: 97151 and 97152 for assessment, 97153 through 97158 for treatment, and the Category III codes 0362T and 0373T for team-based work with harmful behavior. All 10 are time-based in 15-minute units, most require a credential modifier (HM, HN, or HO), and all 10 sit permanently on the CMS telehealth list as of January 2026. Two things changed this year that older references miss: several state Medicaid programs stopped paying for concurrent 97153 and 97155, and on September 9, 2026 the AMA published the six new 2027 codes (97148, 97149, 97159, 97160, 97173, 97180) that replace the T-codes and split direct provider treatment out of 97155 starting January 1, 2027.

TL;DR

• 10 active CPT codes cover all ABA services: 97151 through 97158, plus 0362T and 0373T
• Every code is time-based, billed in 15-minute units. For 2026 the 8-minute rounding convention is a payer-by-payer question, not a universal rule; for 2027 the ABA Coding Coalition's guidance applies the CPT rule (8 to 22 minutes is one unit, under 8 minutes is not reportable)
• Credential modifiers (HM, HN, HO) are required on most claims and are a top denial trigger when missing
• Telehealth is permanently approved for all ABA codes starting January 2026, but some state Medicaid programs cover only a subset of codes via telehealth
• Concurrent billing of 97153 and 97155 is being restricted state by state, with Vermont's ban effective January 1, 2026
• Six new CPT codes arrive January 2027, and the numbers are now published: 97148, 97149, 97159, 97160, 97173, and 97180 (AMA CPT 2027 code set, September 9, 2026). 0362T and 0373T are deleted the same day

How This Reference Is Sourced

Disclosure: VG Soft Co sells ABA practice management software (VGPM) and outsourced billing services (RCM). This reference exists because our own billing team needs it, and the last section explains what our software does about code validation. The code rules themselves come from primary sources, cited inline, so you can check every one.

Everything below is verified against primary sources rather than secondary billing blogs: the ABA Coding Coalition for code definitions and advocacy status, the AMA's CPT program for code set governance, CMS's CY 2027 Physician Fee Schedule proposed rule for 2027 valuation and telehealth proposals, the AMA's CPT 2027 release for the new code numbers, the CMS telehealth services list and place of service code set for billing mechanics, and the BACB for credential requirements. The 2027 descriptor and reporting-rule details below come from the Coalition's ABA Coding Coalition's supplemental guidance (cited by page), which is an interpretation meant to supplement the AMA's CPT 2027 Professional Edition rather than a payer policy.

Two honest limits on any published code reference, including this one:

• Published is not payable yet. The 2027 code numbers below are official as of the AMA's September 9, 2026 release, but they cannot appear on a claim before January 1, 2027, and Medicare valuation and telehealth status are still proposed, not final, until CMS issues the CY 2027 fee schedule final rule (expected November 2026). Payers set their own coverage and rates after that.
• Payer policy beats general guidance. Unit caps, concurrent billing, modifier requirements, and telehealth coverage vary by payer and by state, and they changed mid-year in 2026. Your payer's own provider manual is the only authority for your claims.

Last verified: October 29, 2026.

Assessment Codes

Assessment codes cover the evaluation work that drives treatment planning. These are typically billed less frequently than treatment codes but carry higher per-unit reimbursement and stricter documentation requirements.

97151 is unique among ABA codes because it allows billing for indirect time. When a BCBA spends 45 minutes administering an assessment face-to-face and another 90 minutes scoring it, reviewing records, and writing the treatment plan, all of that time is billable under 97151. Most payers require the completed assessment report as supporting documentation.

97152 is the technician counterpart. An RBT conducting structured preference assessments or administering standardized tools under BCBA direction bills this code. Only face-to-face time counts here.

0362T applies to a narrow but important scenario: assessing severe destructive behavior that requires a team of two or more technicians in a specially designed environment with the BCBA present on-site. This code is being retired in the 2027 code update.

Treatment Codes

Treatment codes make up the bulk of ABA billing. Code 97153 alone accounts for the majority of claims at most practices because it covers direct one-on-one therapy delivered by RBTs.

A few distinctions trip up even experienced billers:

97153 vs. 97155: The line between these two codes is where the technician's role ends and the BCBA's begins. If an RBT is running a program exactly as the BCBA designed it, that's 97153. If the BCBA steps in and modifies the protocol during the session, changes targets, or adjusts reinforcement strategies on the fly, that's 97155. Some payers allow billing both simultaneously when the BCBA is supervising and modifying while the RBT provides direct treatment. Others don't. Check your payer contracts.

97156 is often underutilized. Parent and caregiver training is a billable service that improves treatment outcomes and strengthens your clinical case for continued authorization. If your BCBAs are conducting parent training but you're not capturing it as 97156, you're leaving revenue on the table.

Modifiers That Make or Break Your Claims

Modifiers tell the payer who delivered the service, where it happened, and under what conditions. Missing or incorrect modifiers are one of the most common reasons ABA claims get denied.

Credential Modifiers

Most payers require a modifier indicating the rendering provider's credential level:

If your BCBA bills 97155 without the HO modifier, some payers will deny the claim outright. Others will process it but at a lower reimbursement rate. Neither outcome is good.

Telehealth Modifiers

With all ABA codes now permanently on the CMS telehealth list as of January 2026, telehealth billing is straightforward:

• GT : Telehealth (general, often used for asynchronous)
• 95 : Synchronous audio-video telehealth
• Place of Service 02 : Telehealth delivered to the patient's home

State licensure laws and individual payer policies still apply. Just because CMS covers telehealth for 97155 doesn't mean every commercial payer in your state will reimburse it at the same rate as in-person services.

Place of Service Codes

The 8-Minute Rule and Unit Billing

Every ABA CPT code is time-based and billed in 15-minute units. Many payers apply the 8-minute rule, borrowed from Medicare's therapy billing conventions, to decide whether a partial unit is billable:

• 0 to 7 minutes: Not billable (0 units)
• 8 to 22 minutes: 1 unit
• 23 to 37 minutes: 2 units
• 38 to 52 minutes: 3 units
• 53 to 67 minutes: 4 units

The pattern continues in 15-minute increments. You need at least 8 minutes of a new unit to bill for it. A 52-minute session is 3 units. A 53-minute session crosses the threshold into 4 units.

One caveat worth checking before you rely on this. The 8-minute rule is a convention, not a universal ABA billing rule. Some payers require full 15-minute increments with no partial-unit credit, and others publish their own rounding table. Pull the rounding language out of each payer's provider manual and configure your billing rules per payer rather than applying one rule across your whole payer mix.

2027 update. The ABA Coding Coalition's ABA Coding Coalition's supplemental guidance states that all 2027 ABA CPT codes are timed in 15-minute increments and that a service may be reported once half the increment is met: work lasting 8 to 22 minutes is one unit, and work under 8 minutes is not reportable (p. 31). That is the Coalition's reading of CPT's time-based rule for the new code set, so keep checking each payer's own adjudication rules before you configure billing logic.

Daily Unit Caps

Payers set different maximum daily units:

• Medicare: Typically caps 97151 at 8 units/day; other codes vary
• Medicaid: Varies significantly by state. Some cap 97153 at 32 units/day; others set lower limits
• Commercial: Usually follows the authorization, not a hard daily cap

Concurrent Billing: The 2026 State-by-State Crackdown

Can you bill 97153 and 97155 for the same time period? This is the most contentious question in ABA billing, and 2026 is the year several state Medicaid programs answered it with a no.

The clinical argument for concurrent billing is straightforward: when a BCBA modifies a protocol in real time while an RBT delivers treatment, two distinct billable services are happening at once. The payer argument is equally straightforward: the child received one hour of face-to-face care, so the program pays for one hour. Vermont's own analysis concluded that concurrent billing had inflated authorized tier hours by roughly 12%.

Here is where the restrictions landed, based on the formal challenges the ABA Coding Coalition filed with each program:

The Coalition, whose members include the Association of Professional Behavior Analysts, the Behavior Analyst Certification Board, the Council of Autism Service Providers, and Autism Speaks, is arguing that these restrictions conflict with the intent of the code set. None of the challenges had reversed a policy as of July 2026.

What this means operationally. Three things, in order of urgency:

1. Re-verify concurrency for every payer you bill, not just the ones in this table. Policies changed mid-year in 2026, and a policy you confirmed in 2025 may no longer hold. Get the answer in writing from the provider manual, not from a phone rep.
2. Model the revenue impact before it hits. If a program you depend on bans concurrency, the affected hours do not move to another code. Vermont's 12% tier-hour figure is a reasonable order of magnitude for what a concurrency ban removes from authorized volume.
3. Separate supervision from billable treatment in your scheduling. Where concurrency is barred, BCBA protocol modification needs its own scheduled, documented block rather than riding along on the technician's session.

What the 2027 code set says about concurrency. The Coalition's guidance (pp. 23, 32) says 97155 may be reported concurrently with the technician-delivered codes 97148, 97149, 97153, 97154, 97159, and 97160 when both descriptors are met, and that 97155 is always reported alongside one of them. It may not be reported concurrently with 97152 (the QHP is not required to be present for a supporting assessment, and their time is not billable if they are) or with 97173 (which already includes the QHP's analysis). 97158 is for QHP-led groups and is not reported with 97154; 97155 pairs with 97158 only when a second QHP joins to direct the QHP leading the group. A single QHP cannot report 97153 and 97155 for the same time (p. 16). These are the Coalition's reading of the codes, and the state Medicaid restrictions above still decide what each program pays.

2026 Regulatory Updates

Several changes affect how ABA practices bill in 2026:

Telehealth goes permanent at the federal level, with state exceptions. CMS moved all ABA CPT codes (97151 through 97158, 0362T, 0373T) to the permanent telehealth list effective January 1, 2026, which eliminates the uncertainty of provisional year-to-year extensions. State Medicaid programs did not all follow. Vermont narrowed ABA telehealth coverage to 97155, 97156, and 97157 in the same month, so a code on the federal list can still be non-covered via telehealth in your state.

Carrier pricing continues, and it is proposed to continue again. CMS extended carrier pricing for ABA codes through 2026, meaning there is no CMS-set conversion factor for these services and providers negotiate rates directly with individual payers. The proposed CY 2027 fee schedule extends carrier pricing through 2027 and applies it to the six new codes as well. Your payer contracts and fee schedule negotiations remain the whole ballgame on rates.

Documentation scrutiny is increasing. Payers are tightening their review of session notes. Every note must clearly support the CPT code billed: the specific interventions used, the client's response, and how the session connected to treatment plan goals. Vague or templated notes are triggering recoupment audits at a higher rate than in previous years.

State Medicaid programs continue to diverge. Reimbursement rates, authorized units, supervision requirements, and concurrent billing rules vary widely by state. What works in Texas may get denied in California. If your practice operates across state lines, you need state-specific billing procedures.

What's Coming in 2027: The CPT Code Overhaul

The ABA Coding Coalition announced that the AMA CPT Editorial Panel approved major changes to the ABA code set in September 2025. This is the biggest update to ABA billing codes since the current code set was introduced.

The confirmed shape of the change:

• Six new CPT codes will be added to the ABA code set
• Existing Category I codes (97151 through 97158) will be revised, along with the guidelines governing how the set is used
• Category III T-codes (0362T and 0373T) will be deleted
• Changes take effect January 1, 2027
• The code numbers were confidential under AMA CPT rules until the AMA released the CPT 2027 code set on September 9, 2026 (299 new codes across all of medicine, six of them for adaptive behavior services). The ABA Coding Coalition confirmed the release on September 10 and has since published ABA Coding Coalition's supplemental guidance, with the descriptor, a typical patient, clinical examples, and frequently asked questions for each code. The AMA's CPT 2027 Professional Edition remains the authoritative source for descriptors and guidelines, and the Coalition's document directs readers to the AMA store for it.

The Six New Codes, Published September 9, 2026

Most ABA code references still describe the 2027 codes as a black box, or stop at the CMS placeholders. Neither is current. The AMA released the CPT 2027 code set on September 9, 2026, and the six adaptive behavior codes now have numbers. The table maps each one to the placeholder CMS used in the proposed CY 2027 Medicare Physician Fee Schedule (file code CMS-1848-P, July 14, 2026), matched by descriptor, so readers who planned from the July rule can carry their work forward.

The existing set is revised too, and the Coalition's guidance now spells out how. The headline change: "protocol modification" is replaced by "analysis" in the descriptors of every code administered by a physician or other qualified health care professional (97155, 97173, 97156, 97157, 97158, and 97180). Analysis is the QHP's cognitive work: observing the patient's or caregiver's responses and deciding whether targets or protocols need adjusting. It may not be performed by a technician, it must be documented clearly in the session note, and an adjustment is not required to bill (pp. 1, 2). Actually rewriting a written protocol, goal, or target is reported separately with 97180 (p. 22).

The other descriptor changes the guidance describes:

• 97155 is redescribed as direction of a technician with analysis by the qualified provider, is no longer a dual-use code, and is always reported alongside a technician-delivered code (pp. 21 to 23). Its direct-treatment component moves to 97173.
• 97156 through 97158 add "with analysis" to their descriptors, and 97156 adds language that the service includes discussing protocols and treatment targets and/or training caregivers (p. 25).
• 97152 through 97154 drop the "under the direction of" phrasing (pp. 5, 15, 16).
• Group size: the prior maximum of 8 patients in a group has been removed from the 2027 code set; payer-specific limits are separate from CPT guidance (p. 17).
• Time rules: only face-to-face time is reported for every code except 97151 and 97180, and the mere presence of the patient during QHP activities does not make them billable. Time before the patient arrives or after they leave is not reportable unless it involves a listed 97180 activity (p. 2).
• Deleted codes: 0362T and 0373T are deleted, and the guidance says they are invalid for dates of service on or after January 1, 2027, with no grace period (p. 28).

The set goes from 10 codes to 14. Exact descriptor wording is AMA copyright and is in the 2027 CPT Professional Edition; the paraphrases here are for orientation, not for your charge master.

Comment Period Closed September 14: What to Watch in the November Final Rule

The CMS-1848-P comment period closed on September 14, 2026. The ABA Coding Coalition said it would ask CMS to add the six new codes to the Medicare telehealth list with a permanent designation for 2027. The final rule is expected in November 2026, and these are the four open items that matter for ABA practices:

1. Telehealth status of the new codes. CMS proposed keeping 97151 through 97158 on the permanent telehealth list for 2027 but said nothing about the six new codes. Whether 97173 and 97180 land on that list decides whether remote BCBA work under the new codes is Medicare-eligible, and most commercial payers follow the CMS list.
2. Valuation. All six new codes and the revised codes carried "C" (carrier-priced) placeholders instead of work RVUs in the proposed rule. CMS proposed extending carrier pricing for adaptive behavior codes through 2027, so there will be no national Medicare rate either way; the question is whether the final rule holds that position.
3. Whether the code set survives unchanged. CMS adopts AMA CPT codes as published, so the numbers will not change, but the final rule can still comment on how it expects the codes to be used, and that commentary shapes Medicaid and commercial policy.
4. Payer adoption timing. State Medicaid programs and commercial payers publish their own 2027 fee schedules and authorization rules after the final rule. Expect a gap between January 1 and the date your payer actually accepts 97180, and get the effective date in writing before you bill it.

The strategic read has not changed, but it is no longer hypothetical: 97180 exists, and the ABA billing model shifts on January 1, 2027. Indirect BCBA work that practices currently absorb as overhead, or stretch to fit inside 97151, becomes separately billable. Practices that already track indirect clinical time at the task level will be able to bill it on day one. Practices that do not track it will spend 2027 reconstructing it.

What Practices Should Do Now

The numbers are published and the effective date is fixed, so the preparation list is concrete:

1. Start tracking indirect BCBA time at the task level now. This is the highest-value preparation available, because of 97180. Log protocol review, data analysis, discharge planning, and technician debriefs as discrete time entries rather than folding them into supervision or absorbing them as overhead. Your Q4 2026 tracking becomes your 2027 baseline and your first authorization request. The 97180 guide has the documentation format.
2. Read the Coalition's ABA Coding Coalition's supplemental guidance and the AMA's CPT 2027 Professional Edition. The guidance walks through each revised descriptor with clinical examples and FAQs, and it encourages providers to get written confirmation from each payer on implementation timelines, rates, and authorization processes before January 1, 2027 (p. 29). The Coalition cautioned providers and payers in July against changing EMR systems before the official publication; that publication has now happened, so vendor and payer conversations can start.
3. Audit your current documentation practices. New codes come with new documentation requirements, the harmful-behavior codes add technician-count elements that your notes will need to support, and under the Coalition's guidance the QHP's analysis must be documented in the session note for 97155, 97173, 97156, 97157, and 97158, including a decision not to adjust anything (pp. 2, 23). Our documentation requirements by payer breakdown covers what payers are enforcing today.
4. Talk to your software vendor, with the code numbers in hand. Your practice management system needs 97148, 97149, 97159, 97160, 97173, and 97180 in its code table, the add-on relationship between 97148/97149 and 97159/97160, and a way to capture non-face-to-face time against 97180 before January 1. Ask for the release date, not a roadmap slot.
5. Review payer contracts. When new codes publish, payers set rates, and carrier pricing means those rates are negotiated rather than dictated. Practices that engage early in fee schedule discussions tend to get better rates than those who accept defaults.

Top Claim Denial Reasons (and How to Prevent Them)

Denied claims cost ABA practices more than the lost revenue on the individual claim. Each denial triggers a cycle of investigation, correction, resubmission, and waiting that consumes staff hours and delays cash flow. Here are the most common ABA denial triggers and what to do about each one.

Authorization expired or units exhausted. The authorization ran out before the claim was submitted, or the practice billed more units than the payer approved. Prevention: track remaining authorized units in real-time and set alerts at 80% utilization. Re-authorization requests should go out at least 30 days before the current auth expires.

Wrong or missing modifier. The claim is missing the required credential modifier (HM/HN/HO) or uses the wrong one for the rendering provider. Prevention: build modifier validation into your claims submission workflow. Your billing software should flag claims where the modifier doesn't match the provider's credential on file.

Documentation doesn't support the code. The session note doesn't demonstrate the service described by the CPT code. A BCBA billing 97155 needs notes showing active protocol modification, not just supervision. Prevention: train clinicians on what each code requires in the note. Periodic documentation audits catch patterns before payers do.

Timely filing deadline missed. Commercial payers typically require claims within 90 days; Medicaid programs allow up to 365 days in most states, but some have shorter windows. Prevention: submit claims within 48 hours of the service date. Batch billing at the end of the month creates unnecessary filing risk.

Concurrent billing violation. The practice billed overlapping codes for the same client and time period, and the payer doesn't allow it. Prevention: verify each payer's concurrent billing policy and configure your billing system to flag potential overlaps before submission.

How VGPM automates code validation. VGPM runs pre-submission validation on every claim: code-modifier compatibility, authorization unit availability, rendering provider credentials, and timely-filing windows. The result is a 95%+ clean claim rate and The Hands-Free Billing Engine: the only ABA billing software that runs hands-free on clean claims, closing 85 to 95% of them end to end without manual review.

If your practice is seeing denial rates above 5% on a consistent basis, or if your billing team is spending more time on appeals than on clean claim submission, it may be time to evaluate whether your current billing setup is protecting your revenue or quietly leaking it. Our comparison of in-house vs. outsourced billing models breaks down the real costs and trade-offs, and our ABA claim denial management service details the root-cause triage and payer-specific appeal workflow that keeps preventable denials from repeating.

Code-by-Code Reference: All 10 Active ABA CPT Codes

Each code below carries its own denial pattern and its own 2027 outlook. Jump to the one you're billing.

CPT 97151: Behavior Identification Assessment

Billed by a BCBA or other qualified provider in 15-minute units. The only ABA code that covers both face-to-face and non-face-to-face time, including scoring, record review, and treatment-plan writing. Medicare typically caps it at 8 units per day; commercial and Medicaid caps vary. Most common denial: billed without the completed assessment report on file, or units exceeding the authorization. 2027 outlook: revised, and the Coalition's guidance moves the day-to-day indirect work it currently absorbs to the new non-face-to-face code 97180. 97151 stays the code for initial assessment and reassessment, including writing or revising the treatment plan and report. The two cannot be reported on the same day for the same patient (pp. 4, 5).

CPT 97152: Behavior Identification Supporting Assessment

Billed by a technician working under BCBA direction, 15-minute units, face-to-face time only. Covers structured preference assessments and standardized tools the BCBA designed. Most common denial: indirect technician time billed here (it is not payable), or a missing HM modifier. 2027 outlook: revised. The QHP is not required to be present for a 97152 session, and if they are, their time is not billable and cannot be reported concurrently as 97155. QHP time spent training the technician on the assessment protocol without the patient is reported with 97180 (pp. 6, 32).

CPT 97153: Adaptive Behavior Treatment by Protocol

Billed by a technician, 15-minute units, one-on-one and face-to-face. The highest-volume ABA code at nearly every practice. Most common denial: authorization units exhausted, missing HM modifier, or a session note that does not evidence protocol implementation. Increasingly also concurrency denials where it overlaps 97155. 2027 outlook: revised. The Coalition's guidance says 97153 and 97155 may be reported concurrently when both descriptors are met, though a single QHP cannot report both for the same time, and payer rules still decide (p. 16). Watch the Michigan-style documentation duration limits, which cap hours per note rather than per day.

CPT 97154: Group Adaptive Behavior Treatment by Protocol

Billed by a technician for two or more patients, 15-minute units, billed per patient. Most common denial: group size or staffing ratio outside the payer's stated requirement, or billing group and individual treatment in overlapping time. 2027 outlook: revised. The CPT group maximum of 8 patients is removed, and the guidance has the technician's 97154 reported for each patient attending, with a QHP who joins to direct the technician reporting 97155 only for the patients whose protocols they actually address (p. 17).

CPT 97155: Adaptive Behavior Treatment with Protocol Modification

Billed by a BCBA or other qualified provider, 15-minute units. May include simultaneous direction of a technician, where the payer allows it. Most common denial: concurrency with 97153, and notes that document supervision rather than active protocol modification. 2027 outlook: revised. "Protocol modification" becomes "analysis." Direct provider treatment splits out into new code 97173; 97155 narrows to technician direction with analysis, is no longer dual-use, and is always reported alongside a technician-delivered code. Analysis is billable whether or not the protocol changes, but it must be documented, and adjusting the written protocol afterward is reported with 97180 (pp. 22, 23).

CPT 97156: Family or Caregiver Adaptive Behavior Treatment Guidance

Billed by a BCBA or other qualified provider, 15-minute units, with or without the patient present. The most underbilled code in the set: parent and caregiver training is billable, improves outcomes, and strengthens the clinical case for continued authorization. Most common denial: no documented link between the caregiver session and treatment-plan goals. 2027 outlook: revised, and it remains on the telehealth list in states that narrowed coverage. The descriptor now says "with analysis" and specifies discussing protocols and treatment targets and/or training caregivers. The Coalition's guidance says check-ins with a caregiver are billable only when tied to the patient's treatment targets, possible future targets, or caregiver training on them (p. 25).

CPT 97157: Multiple-Family Group Adaptive Behavior Treatment Guidance

Billed by a BCBA or other qualified provider for two or more families or caregivers, 15-minute units. Most common denial: payer does not cover the multiple-family format at all, which is common enough that you should verify before scheduling a group. 2027 outlook: revised. The guidance has 97157 reported once for each patient whose caregiver or set of caregivers attended, and says it cannot be used for siblings of one family with a single caregiver participating; that is 97156 (p. 27).

CPT 97158: Group Adaptive Behavior Treatment with Protocol Modification

Billed by a BCBA or other qualified provider for two or more patients, 15-minute units. Most common denial: same group-composition and ratio issues as 97154, plus notes that do not show modification for each patient billed. 2027 outlook: revised, with "analysis" replacing "protocol modification." The Coalition's guidance has 97158 reported for each patient attending a QHP-led group, never concurrently with 97154 (pp. 17, 28).

CPT 0362T: Exposure-Based Behavioral Assessment (Team)

A Category III code for assessing severe harmful behavior that requires two or more technicians in a customized environment with the BCBA on-site, 15-minute units. Most common denial: Category III codes carry no assigned relative value and many payers do not cover them at all, so denials here are usually coverage denials rather than coding errors. 2027 outlook: deleted January 1, 2027, and invalid for dates of service on or after that date with no grace period (Coalition guidance, p. 28). New codes 97148 (base) and 97149 (add-on per additional technician) carry the concept forward as permanent Category I codes.

CPT 0373T: Exposure-Based Behavioral Treatment (Team)

The treatment counterpart to 0362T, same team and environment requirements, 15-minute units. Most common denial: coverage, same as 0362T. 2027 outlook: deleted January 1, 2027, with 97159 (base) and 97160 (add-on per additional technician) as the permanent Category I replacement pair.

For authoritative code definitions and updates, refer to the ABA Coding Coalition's billing codes page and the BACB's supervision and credentialing requirements. For denial-code language on your remittance advice, the X12 claim adjustment reason codes are the canonical reference.

Where Medicaid Coverage Comes From

One structural point that explains why state rules vary so much. Federal law requires state Medicaid programs to cover medically necessary ABA for children under EPSDT, the early and periodic screening, diagnostic, and treatment benefit. EPSDT mandates the coverage but leaves each state to define the operational details: rates, unit caps, supervision ratios, telehealth scope, and concurrency. That gap is why a code can be federally listed for telehealth and still be non-covered in your state, and why cross-state practices need per-state billing procedures rather than one national policy.

Update Log

• October 29, 2026 (factual update): Checked the 2027 sections against the ABA Coding Coalition's supplemental guidance. Added that "protocol modification" is replaced by "analysis" in the QHP-administered descriptors; that 97155 is no longer dual-use and always accompanies a technician-delivered code; that the CPT rounding rule (8 to 22 minutes is one unit) applies to the 2027 codes; the 2027 concurrency rules for 97155; the removal of the 8-patient group maximum; the on-site QHP requirement for the harmful-behavior codes; and the no-grace-period deletion of 0362T and 0373T. Rewrote the 97151 outlook, which had said indirect work "may move" to 97180. Removed the explainer-webinar dates, which have passed. No 2026 code rules changed.
• September 18, 2026 (substantive update): The AMA published the CPT 2027 code set on September 9, so the six new adaptive behavior codes now have numbers: 97148, 97149, 97159, 97160, 97173, 97180. Every passage that described them as confidential until late 2026, or as CMS placeholders 97X1X through 97X6X, was rewritten; the placeholder-to-code mapping is kept in the 2027 table for readers who planned from the July proposed rule. The CMS-1848-P comment period closed September 14, and the "proposed is not final" caveat became a four-item watch list for the November final rule. Two FAQ answers, the short answer, the TL;DR, and the 97155, 0362T, and 0373T outlooks were updated to match. No 2026 code rules changed.
• July 24, 2026: Added the 2027 section built on CMS's proposed CY 2027 fee schedule, the state-by-state concurrent-billing crackdown, and the 2026 telehealth permanence.

Staying Ahead of Billing Changes

ABA billing is getting more complex, not less. The 2027 code overhaul, tightening documentation standards, mid-year concurrency reversals, and state-by-state Medicaid divergence all add operational burden to practices that already have too much on their plates. The practices that protect their revenue are the ones that treat billing compliance as an ongoing discipline, not a set-it-and-forget-it task.

That means regular code audits, proactive authorization tracking, clean documentation habits (the session-note mistakes that trigger denials are a useful place to start), and staying current with payer policy changes. Whether you manage billing with your own team, compare ABA billing software options, use a dedicated ABA billing service, or build your workflows around the right ABA practice management software, the goal is the same: every session you deliver should turn into revenue you collect.