ABA is the only service we bill where the main risk is not the claim. It is the authorization. Units are delivered daily by technicians, authorized in blocks months in advance, and reconciled by nobody until the denials arrive. By then the therapy has been provided and the money is gone.
Our ABA billing services treat unit reconciliation as the core job and the claim as the output. Whether you call it ABA therapy billing services or ABA insurance billing services, the reconciliation is what decides whether the month pays. If you are not yet enrolled with the payers you need, start with ABA credentialing services.
The ABA code set
| CPT | Service | Billed by |
|---|---|---|
| 97151 | Behaviour identification assessment, per 15 min | BCBA / QHP |
| 97152 | Behaviour identification supporting assessment, per 15 min | Technician under direction |
| 97153 | Adaptive behaviour treatment by protocol, per 15 min | Technician (RBT) |
| 97154 | Group adaptive behaviour treatment by protocol, per 15 min | Technician |
| 97155 | Adaptive behaviour treatment with protocol modification, per 15 min | BCBA / QHP |
| 97156 | Family adaptive behaviour treatment guidance, per 15 min | BCBA / QHP |
| 97157 | Multiple-family group guidance, per 15 min | BCBA / QHP |
| 97158 | Group adaptive behaviour treatment with protocol modification, per 15 min | BCBA / QHP |
| 0362T / 0373T | Behaviour identification supporting assessment and treatment with protocol modification, severe problem behaviour | Requires two or more staff; payer-specific |
Every code is in 15-minute units, which means rounding rules, daily unit caps and concurrent-billing rules all apply, and each payer writes them slightly differently.
Authorization and unit tracking
This is where ABA practices lose money
An authorization grants a fixed number of units per code, per client, for a fixed period. Sessions are delivered daily against it. Nobody notices the block is exhausted until a claim is denied, six weeks after the therapy was delivered, by which time the payer will not backdate.
We run a weekly reconciliation per client:
- Units authorized, units billed, units delivered but not yet billed, units remaining
- Days remaining in the authorization period, so a renewal is filed before the last session, not after
- Concurrent billing conflicts: a BCBA billing 97155 while a technician bills 97153 for the same client is allowed by some payers and denied by others
- Rendering and supervising provider still active on the roster and still on the authorization
Medicaid and commercial run differently
- Medicaid is usually the larger payer and the stricter one: named RBT registration, supervision ratio documentation, sometimes a diagnosis from an approved provider type before services can start. Every managed care plan on top of the state program has its own authorization portal.
- Commercial plans pay better per unit but authorize in smaller blocks, review treatment plans more often, and are more likely to apply concurrent-billing restrictions.
What we do every week
- Eligibility and benefit checks, including the ABA-specific benefit and any visit or unit cap.
- Authorization submission for assessments, treatment plans and renewals.
- Unit reconciliation per client, per code, per authorization period.
- Charge entry from session notes, with rounding and daily caps applied.
- Claim submission and clearinghouse rejection work.
- Denial management: worked and appealed, with the authorization evidence attached.
- Payment posting and underpayment checks against contracted unit rates.
- Roster monitoring so a departed BCBA never sits on an active authorization.
- Monthly reporting on collections, unit utilization and denial reasons.
Billing and credentialing together
- Not enrolled yet?ABA credentialing services agency enrollment, state Medicaid and roster management.
- Psychologists and PMHNPs on staff?Mental health credentialing for the diagnostic and prescribing side.
ABA billing FAQs
Why are our claims denied when we have an authorization?
Usually the units are exhausted, the authorization period has ended, the rendering provider on the claim is not the one on the authorization, or two codes were billed concurrently in a way that payer does not allow. All four are visible in a weekly reconciliation and invisible without one.
Can a BCBA and an RBT bill for the same client at the same time?
Some payers allow 97155 and 97153 concurrently, for a limited amount of overlap, and some deny it outright. It is a payer-by-payer rule and we set it per contract rather than assuming.
How are units rounded?
ABA codes are 15-minute units and most payers apply a mid-point or an 8-minute style rule, with a daily cap. The rules differ enough between payers that a single global setting in the practice software will produce denials somewhere.
Do you bill Medicaid ABA?
Yes, including the managed care plans that sit on top of the state program. It is usually the larger share of an agency's revenue and the one with the strictest documentation requirements.
Can you work our aged AR?
Yes. ABA AR ages in large chunks because a single authorization problem affects months of units for one client. That also makes it worth working, the recoveries are rarely small.
Talk to an ABA biller
Send us your authorization list and a month of claims. We will show you the unit gap between what was authorized, what was delivered and what was paid.
Schedule a billing demo Talk to a billing expert