Group adaptive behavior treatment by technician, face-to-face, per 15 minutes

Description

This code is used for group adaptive behavior treatments administered by a technician under the supervision of a qualified healthcare professional. The service targets developmental disabilities and maladaptive behaviors, focusing on improving social skills and communication, and is billed in 15-minute increments for sessions involving two or more patients.

Medicare Hospital Outpatient Reimbursement (OPPS)

OPPS Payment Rate

$29.79

Calculation:

x=$29.79

Patient Copayment / Coinsurance

$5.96

Calculation breakdown:

Minimum (20% of rate)$5.96

Top Modifiers

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List View

HCPCS/CPT HOProvider with master's degree level education(25%)

HCPCS/CPT AJClinical social worker services(25%)

HCPCS/CPT QJServices provided to patients in state or local custody(12.5%)

HCPCS/CPT GAWaiver of liability statement issued per payer policy(12.5%)

Code Crosswalks

No crosswalks found.

Alternate Codes

No alternates found.

Billed With Codes

No codes found here.

Sources

We make no claims to ownership of the coding systems referenced on this platform. Codes and descriptions are produced from claims and chargemaster data available through the CMS-9915-F Transparency in Coverage Final Rule and via state or federal datasets. This service is provided solely as a reference to encourage use of these codes in our chargemaster review and automated billing tools, so that healthcare professionals can understand and correctly report these codes in their claims.

Federal and State Datasets

List of CPT/HCPCS Codes, Centers for Medicare & Medicaid Services (CMS)
I/OCE Quarterly Release Files, Centers for Medicare & Medicaid Services (CMS)
Physician Fee Schedule Relative Value Files, Centers for Medicare & Medicaid Services (CMS)
OPPS Addendum B, Centers for Medicare & Medicaid Services (CMS)
ASC Payment Addenda, Centers for Medicare & Medicaid Services (CMS)