2025 CPT code 97154
(Active) Effective Date: N/A Revision Date: N/A Medicine - Adaptive Behavior Services Medicine Services and Procedures Feed
Group adaptive behavior treatment administered by a technician under physician direction, face-to-face with 2-8 patients (15-minute increments).
Modifiers may be applicable depending on the circumstances of service delivery. Consult the CPT manual and payer specific guidelines for appropriate modifier usage.
Medical necessity for 97154 is established by the presence of deficient adaptive behaviors (e.g., impaired social skills, communication deficits, self-care difficulties), maladaptive behaviors (e.g., self-injurious behavior, aggression), or other impaired functioning secondary to these behaviors.Documentation must clearly establish the patient's specific needs, goals, and the appropriateness of group therapy as an intervention strategy.
The supervising physician or qualified healthcare professional is responsible for designing the treatment protocol and may provide direction during the session. The technician administers the treatment under the physician's supervision. The physician maintains overall responsibility for patient care.
In simple words: A trained therapist, overseen by a doctor, works with a small group (2-8 people) to improve behavior and skills.This therapy happens in person and is billed for each 15-minute session.
This CPT code, 97154, represents group adaptive behavior treatment delivered by a technician under the supervision of a physician or qualified healthcare professional.The treatment is conducted face-to-face with two or more patients, but the group size must not exceed eight participants. The service is reported in 15-minute increments. The treatment protocol is pre-designed by the supervising physician or qualified professional, who may or may not provide real-time direction during the session.This code should not be used in conjunction with codes 90785-90899, 92508, 96105-96171, or 97150.
Example 1: A group of four children with autism spectrum disorder receives adaptive behavior therapy focusing on improving social interaction skills. The technician implements pre-defined activities under the physician's protocol. Each session is 30 minutes, resulting in two units of 97154 reported., Six adolescents diagnosed with conduct disorder participate in group therapy focused on anger management. The technician guides group discussions and activities, as outlined in a protocol developed by their psychiatrist, utilizing behavior modification techniques.The session spans 45 minutes, resulting in three units of 97154 being reported., A group of seven adults with intellectual disabilities receives adaptive behavior therapy, concentrating on improving daily living skills. The technician, supervised by an occupational therapist, conducts the session according to the treatment plan devised by the therapist. The session lasts for one hour, resulting in four units of 97154 being reported.
Detailed treatment plan developed by the physician or qualified healthcare professional, specifying treatment goals, target behaviors, and intervention strategies. Documentation should include frequency and duration of sessions, progress notes describing patient responses to interventions and any modifications made to the protocol.Detailed records of the technician's role and involvement in the sessions. Assessment data demonstrating the need for therapy.
** This code is often used in the context of Applied Behavior Analysis (ABA) therapy.Always refer to the most current CPT manual and payer-specific guidelines for accurate coding and reimbursement.
- Payment Status: Active
- Modifier TC rule: Not applicable
- Specialties:Psychiatry, Psychology, Occupational Therapy, Speech-Language Pathology
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital, School, Other Place of Service