CPT® Code 97155

Official Description

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

Common Language Description

Adaptive behavior treatment with protocol modification, as described by CPT® Code 97155, involves a structured approach to addressing behavioral deficits in patients. This treatment is delivered face-to-face by a physician or another qualified healthcare professional, ensuring direct interaction and personalized care. The primary goal of this procedure is to modify existing treatment protocols to better meet the needs of the patient, particularly when previous strategies have proven ineffective or when the patient has plateaued in their skill development. The modifications may include adjustments to treatment goals, targets, and the overall administration of the session, all aimed at enhancing the patient's ability to develop essential skills in various contexts, such as during mealtimes, playtime, and self-care activities. The qualified professional not only implements these changes but also guides and supervises technicians in the application of the new protocols, providing necessary feedback to ensure effective delivery of the treatment. This code is billed for each 15-minute increment of face-to-face interaction focused on protocol modification, highlighting the ongoing nature of adaptive behavior treatment in response to the patient's evolving needs.

1. Indications

The indications for utilizing CPT® Code 97155 include the following:

Behavioral Deficits The patient exhibits specific behavioral deficits that require targeted intervention and skill development.
Minimal Improvement The patient has shown minimal or no improvement with the previously designed treatment protocol, necessitating a reassessment and modification of the approach.
Plateau in Skill Development The patient has reached a plateau in their skill development, indicating that the current strategies are no longer effective and require adjustment.

2. Procedure

The procedure for administering adaptive behavior treatment with protocol modification involves several key steps:

Assessment of Current Protocol The qualified healthcare professional begins by reviewing the existing treatment protocol to identify areas where the patient is struggling or has not made progress. This assessment is crucial for determining the necessary modifications to enhance the effectiveness of the treatment.
Modification of Treatment Goals Based on the assessment, the professional modifies the treatment goals and targets to better align with the patient's current needs. This may involve setting new objectives that are more achievable or relevant to the patient's daily life.
Implementation of New Protocols The professional then implements the modified protocols during face-to-face sessions with the patient. This includes integrating new strategies into the patient's routine, such as during mealtimes or playtime, to facilitate skill development in real-life contexts.
Direction of Technicians Throughout the process, the qualified professional may simultaneously direct technicians who assist in the treatment. This includes demonstrating how to apply the new protocols effectively and ensuring that the technicians understand the modifications made to the treatment plan.
Observation and Feedback The professional observes the implementation of the new protocols and provides feedback to the technicians, regardless of whether the patient is present. This ongoing supervision is essential for maintaining the quality of care and ensuring that the treatment is delivered as intended.

3. Post-Procedure

After the adaptive behavior treatment with protocol modification has been administered, the patient may require ongoing monitoring to assess the effectiveness of the new strategies. The qualified professional should continue to evaluate the patient's progress and make further adjustments to the treatment plan as necessary. Additionally, documentation of the modifications made and the patient's response to the new protocols is essential for compliance and future reference. The goal is to ensure that the patient continues to develop the targeted skills and experiences improvement in their behavioral functioning.

Short Descr	ADAPT BEHAVIOR TX PHYS/QHP
Medium Descr	ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN
Long Descr	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
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	24

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)