For services associated with CPT code 97154, billing is typically permitted by specific credentialed professionals.
Billing Eligibility for CPT Code 97154
In the context of Applied Behavior Analysis (ABA) services, precise guidelines dictate which professionals are authorized to bill for particular codes. For CPT code 97154, which represents "Adaptive behavior treatment by protocol, individual," the following professionals are authorized to submit claims:
| CPT Code | Who Can Provide the Service? | Who Can Bill for the Service? |
|---|---|---|
| 97154 | BCaBA, Technician | BCBA-D, BCBA, or licensed mental health provider |
This indicates that while the direct provision of the 97154 service might be performed by a Board Certified Assistant Behavior Analyst (BCaBA) or a technician, the responsibility for billing and the associated claim submission rests with a higher-level credentialed professional. It is essential for practices to ensure that billing is carried out by the appropriately qualified individual to comply with payer requirements and regulatory standards.
