Qualifying Psychologist 97154 U5 UB
BT (with or without bachelor's degree) 97154 U1 UB
Qualifying Psychologist 0366T U5 UB
BT (with or without bachelor's degree) 0366T U1 UB
Qualifying Psychologist 0367T U5 UB
BT (with or without bachelor's degree) 0367T U1 UB
Group Adaptive Behavior Treatment by
Protocol, with 5 to 8 recipients (1st 30
minutes)
1 unit = Initial 30 minutes
Prior Auth: YES
Group Adaptive Behavior Treatment by
Protocol, with 5 to 8 recipients (each
additional 30 minutes)
1 unit = Each additional 30 minutes
Prior Auth: YES
Group Adaptive Behavior Treatment by
Protocol, with 5 to 8 recipients
Note the modifier UB is used to identify
this size of group
In considering the number in the group,
include both Medicaid and non-Medicaid
recipients
1 unit = 15 min (new units for 2019)
Prior Auth: YES
The new proposed rate is the 2018 rate (per 30 minutes) divided
by 2 (to pay for every 15 minutes.) Note that there is no longer
different codes for the initial time and the additional time. The
rate is just per 15 minutes of service.
In considering the number in the group, include both Medicaid
and non-Medicaid recipients.
The modifier U9 and price is being newly added to the ABA fee
schedule. The U2 modifier is not longer on the fee schedule as
the U1 modifier will serve for both the bachelor's and without
bachelor's level practitioner.
97154 replaces
0366T and
0367T for 2019
In considering the number in the group, include both Medicaid
and non-Medicaid recipients.
Use this code for the first 30 minutes of service for the day.
The modifier U9 and price is being newly added to the ABA fee
schedule. The U2 modifier is not longer on the fee schedule as
the U1 modifier will serve for both the bachelor's and without
bachelor's level practitioner.
0366T is no
longer valid for
dates of
service after
12/31/2018
0367T is no
longer valid for
dates of
service after
12/31/2018
Additional time following 0366T taking place on the same day.
In considering the number in the group, include both Medicaid
and non-Medicaid recipients.
The modifier U9 and price is being newly added to the ABA fee
schedule. The U2 modifier is not longer on the fee schedule as
the U1 modifier will serve for both the bachelor's and without
bachelor's level practitioner.