CPT Code 97155 plays an important role in Applied Behavior Analysis (ABA) services, especially when caregiver involvement is essential to a patient’s progress. Whether you’re a provider, biller, or practice administrator, understanding how this code works can help ensure accurate documentation, compliance, and reimbursement.
This ultimate guide breaks down what CPT Code 97155 is, when to use it, billing requirements, and common mistakes to avoid.
What Is CPT Code 97155?
CPT Code 97155 is used to report adaptive behavior treatment with protocol modification that involves caregivers or family members rather than direct one-on-one patient therapy.
Unlike direct ABA therapy codes, 97155 focuses on training caregivers and modifying treatment protocols to support the patient’s progress outside of therapy sessions.
Official Description of CPT Code 97155
CPT 97155 describes:
Adaptive behavior treatment with protocol modification, administered by a physician or other qualified health care professional, which may include simultaneous direction of a technician, face-to-face with one or more caregivers, each 15 minutes.
When Should CPT Code 97155 Be Used?
CPT Code 97155 is appropriate when:
- A qualified healthcare professional (such as a BCBA) is working directly with caregivers
- The session focuses on modifying treatment protocols
- Caregivers are being trained to implement strategies at home or in the community
- The patient may or may not be present
This code is commonly used during:
- Parent or caregiver training sessions
- Family guidance meetings
- Protocol adjustments based on patient progress
Who Can Bill CPT Code 97155?
CPT 97155 must be billed by a physician or other qualified healthcare professional, such as:
- Board Certified Behavior Analysts (BCBAs)
- Licensed behavioral health providers (depending on payer requirements)
Behavior technicians cannot bill this code independently, though they may be supervised during the session.
Time Requirements
- CPT 97155 is billed in 15-minute increments
- Time must be face-to-face with the caregiver(s)
- Documentation must clearly support the time billed
For example:
- 30 minutes = 2 units
- 45 minutes = 3 units
CPT 97155 vs. Other ABA Codes
Understanding how 97155 differs from similar codes is crucial:
- 97153 – Direct adaptive behavior treatment by a technician
- 97151 – Initial assessment
- 97152 – Observation and direction of technician
- 97156 – Family adaptive behavior treatment guidance (without protocol modification)
Key difference:
CPT 97155 includes protocol modification, while some other family-focused codes do not.
Documentation Requirements
Proper documentation is essential for compliance and reimbursement. Notes should include:
- Date and duration of the session
- Names and roles of participants (caregivers, professionals)
- Description of protocol modifications
- Training provided to caregivers
- Clinical rationale for changes
- Patient progress or response (if applicable)
Incomplete documentation is one of the most common reasons for claim denials.
Common Billing Mistakes to Avoid
- Billing 97155 without protocol modification
- Using 97155 for technician-only services
- Insufficient documentation of caregiver involvement
- Overlapping time with other CPT codes
- Billing without meeting payer-specific guidelines
Always verify requirements with individual insurance payers, as coverage policies may vary.
Why CPT Code 97155 Matters
CPT 97155 supports the idea that caregiver involvement is critical to long-term success in behavioral therapy. By properly using this code, providers can ensure caregivers are equipped with the tools they need to reinforce treatment goals beyond clinical settings.
Final Thoughts
CPT Code 97155 is a powerful and necessary component of ABA treatment when used correctly. Understanding when to use it, who can bill it, and how to document it properly can improve compliance, reimbursement, and—most importantly—patient outcomes.