CPT® Code 97153

Official Description

Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes

Common Language Description

Adaptive behavior treatment by protocol, as defined by CPT® Code 97153, is a structured approach aimed at addressing maladaptive or deficient behaviors in patients. This treatment is designed based on prior assessments that identify specific behavioral deficits, such as issues related to social skills, emotional regulation, communication challenges, or the presence of repetitive, harmful, or stereotypical behaviors. The treatment protocol is meticulously crafted by a physician or another qualified healthcare professional, ensuring that it is tailored to meet the individual needs of the patient. During the face-to-face sessions, which are conducted by a technician under the supervision of the qualified professional, the focus is on achieving specific treatment goals. These sessions provide the patient with multiple opportunities to practice the target skills in various real-world settings, including home, community parks, stores, and other environments where the patient may encounter social interactions. The technician plays a crucial role not only in administering the treatment but also in collecting and documenting data regarding the patient's progress. This data is subsequently reviewed by the overseeing physician or qualified professional to assess the effectiveness of the treatment and determine if any adjustments to the protocol are necessary. Each unit of service for this treatment is billed in 15-minute increments, specifically for one patient, allowing for precise tracking of the time spent on delivering these essential therapeutic services.

1. Indications

The indications for adaptive behavior treatment by protocol, as outlined in CPT® Code 97153, include the following conditions and symptoms that necessitate intervention:

Maladaptive Behaviors - These are behaviors that are not conducive to the patient's well-being or social functioning, requiring targeted treatment to promote more appropriate behaviors.
Deficient Behaviors - This includes a lack of necessary skills in areas such as social interaction, emotional regulation, and communication, which can hinder the patient's ability to function effectively in daily life.
Repetitive or Harmful Behaviors - Behaviors that may pose a risk to the patient or others, necessitating intervention to reduce or eliminate these actions.
Stereotypical Behaviors - These are repetitive actions that may not serve a functional purpose and can be addressed through structured treatment protocols.

2. Procedure

The procedure for administering adaptive behavior treatment by protocol involves several key steps, each critical to the overall effectiveness of the treatment:

Step 1: Development of Treatment Protocol - A physician or qualified healthcare professional designs a comprehensive treatment protocol based on initial assessments of the patient's specific behavioral deficits. This protocol outlines the goals and strategies to be employed during treatment sessions.
Step 2: Technician Administration - A trained technician administers the treatment protocol face-to-face with the patient. This involves engaging the patient in activities that target the identified behavioral deficits, providing opportunities for practice and skill development.
Step 3: Data Collection - Throughout the treatment sessions, the technician collects and records data on the patient's performance and progress. This data is essential for evaluating the effectiveness of the treatment and making necessary adjustments.
Step 4: Ongoing Assessment - The physician or qualified professional regularly reviews the collected data to assess the patient's progress towards the treatment goals. This ongoing assessment helps determine if the current protocol remains appropriate or if modifications are needed to better meet the patient's needs.
Step 5: Implementation in Various Settings - The technician administers the treatment in diverse environments, such as the patient's home, community parks, or stores, to ensure that the patient can generalize the skills learned across different contexts.

3. Post-Procedure

Post-procedure care for adaptive behavior treatment by protocol involves continued monitoring and evaluation of the patient's progress. After each session, the technician may provide feedback to the patient and their caregivers regarding the skills practiced and any observed improvements. The physician or qualified professional will review the data collected to determine the effectiveness of the treatment and decide if any adjustments to the protocol are necessary. It is essential to maintain open communication with the patient and their family to ensure that they are aware of the treatment goals and any changes made to the approach. The overall aim is to support the patient in achieving their treatment goals and enhancing their ability to function effectively in various settings.

Short Descr	ADAPTIVE BEHAVIOR TX BY TECH
Medium Descr	ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN
Long Descr	Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes
Status Code	Carriers Price the Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Codes That May Be Paid Through a Composite APC
Type of Service (TOS)	1 - Medical Care
Berenson-Eggers TOS (BETOS)	none
MUE	32

This is a primary code that can be used with these additional add-on codes.

0770T

Add-on Code MPFS Status: Carrier Priced APC E1 Virtual reality technology to assist therapy (List separately in addition to code for primary procedure)

HM	Less than bachelor degree level
UB	Medicaid level of care 11, as defined by each state
59	Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
GO	Services delivered under an outpatient occupational therapy plan of care
GP	Services delivered under an outpatient physical therapy plan of care