Case2Code

Code deleted, see 97153, 97154, 97155, 97156, 97157, 97158, 0373T

Official Description

Adaptive behavior treatment by protocol, administered by technician, face-to-face with one patient; first 30 minutes of technician time

Common Language Description

An adaptive behavior treatment protocol is a structured intervention designed to address and modify maladaptive or destructive behaviors exhibited by individuals, particularly those with developmental disorders or behavioral challenges. This treatment is administered by a technician who has received specialized training from a physician or other qualified healthcare professional, such as a behavioral analyst or licensed psychologist. The primary objective of adaptive behavior therapy is to replace inappropriate behaviors with more suitable alternatives and to enhance deficient adaptive behaviors that may stem from impaired social or communication skills. The treatment protocol is meticulously crafted by the supervising healthcare professional to target specific behavioral issues and set clear goals for improvement. During the therapy session, the technician engages with the patient in a face-to-face setting, documenting the progress and details of the treatment session. This documentation is crucial as it is subsequently reviewed by the supervising physician or qualified professional, who interprets the findings and prepares a comprehensive report on the patient's progress. The CPT® Code 0364T is specifically utilized to bill for the first 30 minutes of this face-to-face technician time with a single patient, while code 0365T is designated for each additional 30 minutes of service provided.

1. Indications

The adaptive behavior treatment protocol is indicated for individuals exhibiting maladaptive behaviors or those requiring improvement in adaptive skills due to various conditions. The following are specific indications for this procedure:

Developmental Disorders Individuals diagnosed with developmental disorders, such as autism spectrum disorder, may benefit from targeted interventions to improve social and communication skills.
Behavioral Challenges Patients displaying destructive or maladaptive behaviors that interfere with daily functioning or social interactions are suitable candidates for this treatment.
Impaired Social Skills Individuals who struggle with social interactions and require assistance in developing appropriate social behaviors may be indicated for adaptive behavior treatment.
Communication Deficits Patients with communication difficulties that hinder their ability to express needs or interact effectively with others may also be appropriate for this therapy.

2. Procedure

The procedure for administering adaptive behavior treatment by protocol involves several key steps, each designed to ensure effective intervention and documentation of the patient's progress. The following outlines the procedural steps:

Step 1: Preparation Prior to the session, the technician reviews the treatment protocol established by the supervising physician or qualified professional. This includes understanding the specific behavioral goals and techniques to be employed during the session.
Step 2: Face-to-Face Interaction The technician engages with the patient in a face-to-face setting, implementing the adaptive behavior treatment protocol. This interaction is crucial for addressing the targeted maladaptive behaviors and introducing appropriate alternatives.
Step 3: Documentation Throughout the session, the technician meticulously documents the patient's responses, behaviors observed, and any interventions applied. This documentation is essential for tracking progress and informing the supervising professional.
Step 4: Reporting After the session, the technician compiles the documented information and reports back to the supervising physician or qualified professional. This report includes an overview of the session, patient engagement, and any notable changes in behavior.
Step 5: Review and Adjustment The supervising professional reviews the technician's report, interprets the data, and may adjust the treatment protocol as necessary to better meet the patient's needs and goals.

3. Post-Procedure

Post-procedure care involves ongoing monitoring and evaluation of the patient's progress following the adaptive behavior treatment sessions. The technician and supervising professional will continue to assess the effectiveness of the treatment protocol and make necessary adjustments based on the patient's response. Regular follow-up sessions may be scheduled to ensure continuity of care and to reinforce the skills learned during therapy. Additionally, the technician may provide feedback to the patient and their family regarding progress and strategies to support behavioral improvements outside of the therapy sessions.

Short Descr	ADAPTIVE BEHAVIOR TREATMENT
Medium Descr	ADAPTIVE BEHAVIOR TX BY PROTOCOL FIRST 30 MIN
Long Descr	Adaptive behavior treatment by protocol, administered by technician, face-to-face with one patient; first 30 minutes of technician time
Status Code	Carriers Price the Code
Global Days	YYY - Carrier Determines Whether Global Concept Applies
PC/TC Indicator (26, TC)	9 - Not Applicable
Multiple Procedures (51)	9 - Concept does not apply.
Bilateral Surgery (50)	9 - Concept does not apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	9 - Concept does not apply.
Co-Surgeons (62)	9 - Concept does not apply.
Team Surgery (66)	9 - Concept does not apply.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Procedure or Service, Not Discounted when Multiple
Berenson-Eggers TOS (BETOS)	M5B - Specialist - psychiatry
MUE	Not applicable/unspecified.