AMA CPT® Assistant - 2014 Issue 6 (June)
Adaptive Behavior Assessments and Treatment Descriptors for July 1, 2014 Reporting (June 2014)
June 2014 pages 3-10 Adaptive Behavior Assessments and Treatment Descriptors for July 1, 2014 Reporting Current Procedural Terminology (CPT®) Category III Adaptive Behavior Assessment and Treatment codes and guidelines were published on the AMA CPT Web site at www.ama-assn.org/go/cpt (see Related Link-Category III codes) in January and March 2014, for implementation on July 1, 2014, and for inclusion in the CPT® 2015 code set. The Category III codes are a set of temporary codes that provide a uniform mechanism for reporting emerging technology services and procedures and facilitate data tracking and utilization. The Category III codes...
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Article Overview
This CPT Assistant article provides a high-level guide to the Category III adaptive behavior assessment and treatment code family and the reporting context for July 1, 2014. It covers the purpose of the code set, the types of services addressed, how the codes relate to other behavioral and therapy services, and the broad organization of the assessment and treatment descriptors. It is aimed at coders, billers, clinicians, and other professionals working with autism spectrum disorders and related behavioral services who need to understand the scope of the guidance and the categories of reporting discussed.
Why This Topic Matters
The article helps readers identify whether a service belongs in this temporary CPT Category III family and understand the broader reporting framework surrounding adaptive behavior services. It is especially relevant for organizations managing behavioral health, developmental services, and payer-facing coding policy.
Article Sections
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June 2014 pages 3-10
Introductory material describing the article’s publication context and the overall subject of adaptive behavior assessment and treatment reporting.
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Workgroup's Guiding Principles for Code Development
An overview of the general principles used to shape the adaptive behavior assessment and treatment code family and its reporting structure.
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Behavior Identification Assessment
Discussion of the baseline assessment category, including the general purpose of the service and its reporting framework.
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Coding Tip
A brief note on reassessment and the relationship between the initial assessment and follow-up assessment categories.
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Behavioral Follow-up Assessments
General guidance on the follow-up assessment categories, including how they are organized and distinguished at a high level.
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Observational Behavioral Follow-Up Assessment
Overview of the observational follow-up category and the types of behavioral functioning it is intended to evaluate.
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Exposure Behavioral Follow-Up Assessment
Overview of the exposure-based follow-up category and the general clinical situations it is designed to address.
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Adaptive Behavior Treatment
High-level description of the treatment code family, its intended service setting, and its relationship to prior assessments.
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Adaptive Behavior Treatment by Protocol
General discussion of protocol-based treatment delivery for individual and group settings.
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Adaptive Behavior Treatment by Protocol Modification
General discussion of treatment when protocols are modified by the supervising professional and delivered directly to the patient.
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Family and Multiple-Family Group Adaptive Behavior Treatment Guidance
Overview of caregiver-oriented guidance services and their place within the adaptive behavior treatment family.
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Adaptive Behavior Treatment Social Skills Group
General description of the social skills group treatment category and its role in adaptive behavior services.
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Exposure Adaptive Behavior Treatment
Overview of the exposure-based treatment category for severe maladaptive behaviors and the settings in which it is used.
What You Will Learn
- The purpose and scope of the CPT Category III adaptive behavior assessment and treatment family.
- How the article organizes assessment, follow-up, treatment, and caregiver guidance categories.
- Which specialties and service types are discussed in relation to adaptive behavior reporting.
- How the article frames the broader reporting environment for these services.
Who Should Read This
- Medical coders
- Billing and reimbursement staff
- Behavioral health clinicians
- Psychologists
- Behavior analysts
- Compliance and revenue cycle teams
- Health plan policy staff
Codes Discussed
Code Ranges Discussed
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