What is group adaptive behavior treatment?
CPT code 97158 refers to group adaptive behavior treatment with protocol modification in applied behavior analysis (ABA). This service involves a qualified health care professional delivering adaptive behavior treatment guidance to two or more patients simultaneously. The provider uses a treatment plan tailored to each individual, addressing maladaptive behaviors and promoting social skills and adaptive functioning in a group setting.
This code, as maintained by the American Medical Association, differs from CPT code 97157, which is used for multiple-family group sessions. CPT code 97158 is typically used when a behavior treatment protocol is adjusted to accommodate the needs of a group of patients, such as those with autism spectrum disorder, destructive behavior, or deficient adaptive behaviors.
The 97158 CPT code description highlights that services are face-to-face and often involve protocol modification.
Documentation requirements
Proper billing and compliance with payer and AMA guidelines require detailed documentation for CPT code 97158. Document each session with:
- Date, time, and duration of the session
- Group size and composition, including whether there are multiple patients present (must be two or more)
- Specific target behaviors addressed (e.g., peer interaction, social skills group objectives, maladaptive behaviors)
- Therapeutic techniques applied, with details on the patient's behavior, response, and progress
- Any protocol modification administered or adaptations made to the treatment plan
- Objective data related to behavior identification, supporting assessment, and functional outcomes
- A note on how the group context supported the adaptive behavior services, such as through simultaneous direction or shared tasks
- Reference to any relevant behavior identification assessments or data trends from past data
Additionally, ensure that documentation supports medical necessity and links the session to the adaptive behavior treatment procedures outlined in the applied behavior analysis plan. Using thorough documentation helps avoid claim denials and ensures the session is reimbursed by the payer.
Billing guidelines
Here are the medical billing guidelines:
- Report CPT Code 97158 per 15-minute unit of face-to-face adaptive behavior treatment delivered in a group setting.
- Use only when individualized protocol modification is implemented for each patient during the group session.
- Do not report for passive participation, general supervision, or activities not tailored to individual behavior treatment plans.
- Rendering providers must meet credentialing requirements (e.g., Board Certified Behavior Analyst [BCBA] or Qualified Healthcare Professional [QHP]) as defined by payer policies.
- Always check payer-specific requirements for coverage, prior authorization, credentialing, and supervision ratios.
Other relevant CPT codes
- 97153 – 1:1 adaptive behavior treatment
- 97155 – Protocol modification, individual setting
- 97154 – Group adaptive behavior, technician-led
Frequently asked questions
Yes. 97158 in ABA therapy is a time-based code, billed per 15-minute unit per qualified health care professional providing face-to-face services during the group session. Always track the maximum number of units allowed per session based on payer policies.
No. This code is not appropriate for large, passive groups. The group must be small enough to allow individualized protocol modifications, active interaction, and behavior treatment with protocol guidance. The setting should reflect therapeutic intent, not general education.
Qualified health care professionals, such as board-certified behavior analysts (BCBAs) or other licensed practitioners, are typically required. The provider must be capable of making clinical decisions and supervising services, especially when family adaptive behavior treatment or group interventions are involved.
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