The new Tier Model ABA (Applied Behavioral Analysis) Fee Schedule is now available. ABA providers can view the new fee schedule in the online Provider Portal. Please note the updated modifiers and corresponding dates of service moving forward.
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The tier model ABA Fee Schedule updates are loaded in our claims processing system and are effective for dates of service 7/1/2020 and forward (CPT codes 97151-97158, 0362T and 0373T). The most recent fee schedule has been loaded to our Secure Web Portal. The ABA service codes must be billed with the appropriate modifier to identify the experience level of the staff rendering the service.
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For dates of service 6/30/2020 and prior, the old fee schedule is still in place and claims will be reimbursed with the historical rates. Modifiers are not required for claims billed with dates of service 6/30/20 and prior.
Tiers (level of education)
- BHT/RBT - Less Than Bachelor Degree - Modifier HM
- Trainee, Master, BCaBA - Bachelor Degree Level - Modifier HN
- BCBA - Master's Degree Level - Modifier HO
- BCBA-D - Doctoral Level - Modifier HP
The BCBA-D - Doctoral Level - Modifier HP is in the process of being deployed. A targeted e-mail to the ABA providers will be sent when completed.
Mercy Care is committed to providing education and technical assistance to ensure a seamless transition to the tiered ABA model. As always, don't hesitate to contact your Mercy Care Network Management Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy Care website.
Thanks for all you do!
