aba

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    Wiki CMS Telehealth changes 2024 ABA Therapy

    Hello, I am working for an ABA Therapy company and stumbled across the MLN for telehealth coding. According to this document and the list of telehealth-approved codes, ABA therapy can not be performed with audio only. Does anyone have any additional information regarding the new telehealth...
  2. JWash618

    Wiki ABA billing with no Auth (cross posted)

    Is it standard practice to start billing ABA services to insurance companies before an authorization is issued? I thought that billing was not supposed to be done before an authorization was given, but I have been told to bill anyway, sometimes for several months before an authorization comes...
  3. JWash618

    Wiki ABA Billing without a Pre-Auth

    Is it standard practice to start billing ABA services to insurance companies before an authorization is issued? I thought that billing was not supposed to be done before an authorization was given, but I have been told to bill anyway, sometimes for several months before an authorization comes...
  4. E

    Wiki ABA BILLING

    I need some help. I have a client with commercial insurance as primary and Medicaid secondary. Both insurances paid but there is still a 19.00 balance left. I should know what to do but I don't, what do I put it under?
  5. T

    Wiki Cigna / ABA therapy

    Hello there, I am having difficulty with Cigna and hoping someone out there has some advice. We are an out of network provider for Cigna. They send our claims to Multiplan, who contacts us to negotiate a payment. Sometimes we are only offered 10-40% of what we bill. Obviously, I do not accept...
  6. A

    Wiki Modifier XE vs. 59

    I'm looking for guidance on when to use modifier XE vs. modifier 59. For example, an ABA client is seen in the morning for 60 mins for behavior treatment (0364T - first 30 mins & 0365T - additional 30 mins). The client is then also seen later that day for the same service (0365T). Services are...
  7. A

    Wiki Aetna - ABA Therapy Denials

    Hi! I've been working with a billing team on our ABA billing to Aetna. Prior to supplying services, we obtain an authorization for the 4 codes we bill (0364T/0365T and 0368T/0369T). The problem is this: Starting in October, Aetna has denied every claim for 1 out of the 4 kids for "Charges...
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