2025 CPT code 97155
(Active) Effective Date: N/A Medicine - Adaptive Behavior Services Feed
Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes.
Modifiers may be applicable in certain situations to clarify the services provided. For example, modifier 59 may be used to indicate a distinct procedural service.
Medical necessity for this code is established when the existing adaptive behavior treatment protocol requires modification to effectively address the patient's behavioral challenges. Documentation should support the need for the changes and demonstrate how they contribute to achieving the patient's treatment goals.
The physician or other qualified healthcare professional is responsible for modifying the treatment protocol, addressing any issues, and providing direct instruction to the patient and any technicians involved in implementing the modified protocol.
In simple words: This code covers a 15-minute session where a doctor or qualified healthcare professional works directly with a patient to adjust their behavioral treatment plan.The professional may also guide a technician on how to carry out the updated plan during the session.
This code represents adaptive behavior treatment involving protocol modification. It is administered by a physician or other qualified healthcare professional face-to-face with a single patient. The service includes resolving one or more problems with the existing protocol and may involve simultaneously directing a technician in administering the modified protocol while the patient is present.Direction to the technician without the patient present is not reported separately. The service is reported in 15-minute increments.
Example 1: A teenager with autism experiences a change in behavior after moving to a new foster home. The physician modifies the existing behavior plan during a session with the patient to address these changes and instructs the technician on implementing the new plan., A child with ADHD struggles to focus during therapy sessions. The physician modifies the protocol to include shorter, more engaging activities and guides the technician on implementing the changes during the session., An adult with a developmental disability has difficulty transitioning between activities. The physician modifies their treatment plan to incorporate visual aids and provides real-time guidance to the technician on using these aids effectively during the session.
Documentation should include the original treatment plan, the specific modifications made, the patient's response to the modifications, and any instructions provided to the technician. The medical necessity for the modifications should also be documented.
- Payment Status: Active
- Specialties:Behavioral Health, Developmental Pediatrics, Psychiatry, Psychology, Applied Behavior Analysis
- Place of Service:Office, Outpatient Hospital, Home, Inpatient Hospital