Overview
ABA billing is authorization arithmetic. Payers approve a specific number of units per code per period, and going over means the excess is simply unpaid unless the authorization is amended first. On top of that, technician-delivered treatment and analyst-delivered supervision have rules about when they can be billed concurrently, and session documentation has to show start and stop times, the protocol followed, and who delivered it. Most of the money lost in ABA is lost to units that were worked but never authorized.
Why these claims get denied
The denial reasons we see most often in applied behavior analysis, and what our pre-billing checks are built to catch.
- Units billed beyond what the authorization approved for the period
- Technician-delivered treatment billed without the required supervision ratio documented
- 97153 and 97155 billed concurrently where the payer prohibits it
- Session notes missing start and stop times or the specific protocol targeted
- Rendering technician not registered or credentialed with the payer
- Assessment billed without the treatment plan the payer requires on file
- Telehealth-delivered sessions billed without the correct place of service and modifier
A real claim from this specialty
The kind of claim we see every week in applied behavior analysis, and the denial that usually follows it.
Sample claim · single date of serviceApplied Behavior Analysis
97153 x16Adaptive behavior treatment by protocol, 4 hrs$460.00
97155 x2Protocol modification by analyst, 30 min$96.00
97156 x4Family guidance, 1 hr$132.00
Denied: units exceed authorization
How we resolved itThe authorization covered 80 units of 97153 per month and 96 had been delivered. We filed a concurrent increase with progress data, secured retroactive approval, and rebilled the excess units.
What we do for your practice
- Running unit ledger per patient, per code, so you see the authorization ceiling approaching
- Concurrent authorization requests filed with progress data before units run out
- Supervision ratios tracked and documented against each technician's billed hours
- Concurrent-billing rules mapped payer by payer for 97153 and 97155
- Session note audits against time, protocol, and rendering credential
- Technician registration and credentialing maintained with every contracted payer
- Treatment plan renewal calendar so assessments and reauthorizations never lapse
Codes and rules that matter here97151 behavior identification assessment, 97152 supporting assessment, 97153 treatment by protocol, 97154 group, 97155 protocol modification, 97156/97157 family and multiple-family guidance, 97158 group adaptive behavior treatment. Units are 15 minutes unless the payer states otherwise.
Common questions
Why do units deny even when the sessions happened?
Because payment follows the authorization, not the service. If the approval covers 80 units a month and you deliver 96, the extra 16 are unpaid unless you get a concurrent increase approved. We watch the ledger so you can request more before the ceiling is hit.
Can 97153 and 97155 be billed at the same time?
It depends on the payer. Some allow the analyst to bill protocol modification while the technician delivers treatment; others treat it as duplicate time and deny one. We map the rule per contract rather than applying one policy everywhere.
What does a session note need to support the claim?
Start and stop times, the specific protocol or target addressed, the patient's response, and the credential of the person delivering it. Notes that describe the session generally but omit times are the ones that fail on audit.