I had already been in ABA operations for a decade when the 2019 code transition hit. I watched billing departments chase denials on codes that payors technically recognized but hadn't updated in their systems yet. I also saw authorization teams remap hundreds of client authorizations while clinical staff kept documenting on templates which no longer matched. Teams were working feverishly to adapt to the changes, but were uncertain if the broad changes would be adopted by each payor.
On January 1, 2027, the adaptive behavior code family goes from 10 codes to 14. It's the biggest change to ABA billing codes since 2019, and a lot of organizations are anxious about it. That’s reasonable. When ABA therapy billing codes shift, claims can get denied and cash flow can stall. The transition is also manageable if you start now and approach it payor by payor, authorization by authorization.
This guide covers what’s changing, what each role on your team needs to do, and how to get through it without losing claims along the way. There’s a downloadable checklist at the end if you want something your team can work from directly.
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Key takeaways
- The adaptive behavior code family grows from 10 codes to 14 on January 1, 2027. Six codes are new, 97155 takes on a narrower meaning, two temporary codes (0362T and 0373T) retire and seven codes get reworded descriptors.
- 97155 now describes one service: a qualified healthcare professional (QHP) directing a technician with analysis. A QHP treating a Patient one-on-one moves to 97173, and a QHP's non-face-to-face(previously non-billable) clinical work moves to 97180, reported weekly.
- 0362T and 0373T cannot be billed for any date of service on or after January 1.
- A code existing in the CPT book does not mean a payor covers it. Each payor sets its own timeline, rates, and authorization rules.
- Clinicians, technicians, billers, and practice leaders each have different work to do before January.
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What's changing in the ABA CPT code set in 2027
All 14 codes in the 2027 set are permanent Category I codes. The temporary T-codes are gone. Below is every change and what it means in practice.
The 2027 ABA billing code changes at a glance
Six new codes for work your team already does
The six new ABA therapy CPT codes are 97148, +97149, 97159, +97160, 97173, and 97180. They give a code to three kinds of clinical work that either didn't have one or shared a code with something else:
- Harmful behavior services delivered by a team of technicians
- Direct treatment from a QHP (the code set's term for a qualified healthcare professional, such as a BCBA®)
- The clinical work a QHP does when the Patient isn't in the room
97180: non-face-to-face QHP work gets a code of its own
For the first time, the data review you fit in after the last session has its own code.
97180 covers clinical work a QHP personally performs when the Patient isn't in the room. The descriptor lists five specific activities:
- Reviewing and analyzing treatment data and session notes
- Deciding whether to modify targets, goals, or protocols, and making those modifications
- Deciding whether more assessment is needed, and developing or modifying assessment protocols
- Developing a discharge or transition plan
- Training technicians on treatment targets and on implementing assessment or treatment protocols
If an activity isn't on that list, it's not 97180. The code is reported in 15-minute units, once per week for each Patient, adding up that week's total time. It can't be reported on the same day as 97151 for the same Patient. Whether a payor covers it is a separate question.
What's changing with CPT code 97155
97155 keeps its number, but starting January 1 it describes one service: a QHP directing a technician while both are face-to-face with the Patient. It's always reported alongside the technician's own code (97153, 97154, 97148 and +97149, or 97159 and +97160).
Under the 2019 set, 97155 did double duty. It covered both a BCBA coaching an RBT® during a session and a BCBA working with the Patient directly. Those are now two separate codes. When your BCBA models a prompting procedure, hands it to the RBT, and watches them run it, that's still 97155. When your BCBA works with the Patient alone and no technician is delivering the service, that's 97173.
The descriptor also swaps “protocol modification” for “with analysis.” You don't have to change a protocol every time you report 97155. You do have to document that you looked at whether it needed to change and what you decided, including when the answer was to leave it alone.
The session note matters a lot here: it has to make clear whether the QHP was directing a technician or treating the Patient. This is one of the spots where clinical documentation and billing have to be in sync from day one.
0362T and 0373T retire with no grace period
The two temporary Category III codes can't be reported for any date of service on or after January 1, 2027. 0362T (supporting assessment of harmful behavior) is replaced by 97148, and 0373T (treatment of harmful behavior) by 97159. Each new code has an add-on (+97149 and +97160) for the third through fifth technician. 97148 and 97159 are permanent Category I codes, same tier as the rest of the set.
If a Patient's current authorization lists a T-code, whether it's honored, converted, or reissued is up to the payor. The Coalition's guidance says a payor that will honor the authorizations listing deleted codes is expected to issue new authorizations under the replacement codes.
One thing worth flagging about 97148 and 97159: unlike most ABA procedure codes, they’re defined by the setup, not just the service. The Coalition’s guidance defines harmful behavior broadly (self-injury, aggression, elopement, pica, feeding difficulties, and other behavior that puts someone’s health or safety at risk), and the service has to take place in an environment that was configured for that behavior before the session started. That means a second RBT stepping into a regular 97153 session when behavior escalates doesn’t automatically make it a 97159. The customized environment and QHP availability have to be part of the plan going in.
Seven familiar codes with reworded descriptors
97151, 97152, 97153, 97154, 97156, 97157, and 97158 keep their numbers and their core functions. Each got new wording, and a few changes are worth reading closely before your team assumes it's business as usual.
- 97152, 97153, and 97154 drop the phrase “under the direction of” from their descriptors. Check the section guidelines for the updated supervision requirements.
- 97156, 97157, and 97158 now say “with analysis.”
- 97153 stays the technician's code. When a QHP analyzes and adjusts during a session, without the technician present, that work is reported as 97173.
- 97151 spells out its face-to-face and non-face-to-face components more clearly. All parts have to happen to report the code, but they don't have to happen on the same date. Scoring and report writing can spread across days or weeks.
Coverage, rates, and authorizations won't update automatically
Three things won't change on their own when the new codes take effect:
- Whether a payor covers a code
- What it pays
- What it requires to authorize services.
Under HIPAA, health plans have to accept the CPT code set, but the law doesn't govern those three decisions. The ABA Coding Coalition Guidance is direct: payors aren't all required to implement the new codes on January 1.
So, what we saw through the 2019 transition applies now too: each payor moves on its own timeline, and some take considerably longer than others. That’s why it’s important to ask each payor directly and not wait for them to come to you.
The T-codes are the exception. 0362T and 0373T are deleted on January 1 regardless of where a payor is in its adoption process. If a payor isn't ready for 97148 or 97159 by that date, providers will need its guidance on how to handle those services in the interim.
Three ways payors may handle the transition
Important note: these are planning scenarios based on the Coalition's guidance, not announcements from any specific payor.
In 2019, I saw all three play out across different payors at the same time. Some were ready on day one, while others took months. A few required full re-authorization for every Patient, which created a significant admin load, especially for larger practices. The pattern will likely be similar this time.
Medicare: The CMS proposed keeping carrier pricing for all 14 adaptive behavior codes through 2027, including the six new ones. That means there's no national Medicare rate, and providers continue negotiating rates with each payor. CMS also proposed keeping 97151 through 97158 on Medicare's permanent telehealth list and didn't address the six new codes. The Coalition has said it will ask CMS to add them. The final rule is expected in November 2026.
Medicaid: Each state agency works through rate development, system updates, and approvals before it can pay new codes, so timing varies state by state.
What your team needs to do before January 1
Your payors’ answers determine the timeline for everything else, so that’s where you should start.
If you're leading the transition: owners, clinical directors, COOs
Somebody has to own this, and that person needs the authority to pull clinical and billing into the same conversation. In most of the organizations I've worked with, the transition stalls when clinical and billing are operating with different information or when nobody is tracking payor responses in one place.
Start with your payors. The Coalition's template letter gives you a starting point for reaching out. What you need from every payor before January 1 comes down to three things: the implementation timeline, any changes to reimbursement rates, and the authorization process for the new codes. Get every answer in writing and log it in one place your billing and clinical leads can both access.
Keep a payor-by-payor tracker with start dates, authorizations affected, and who owns each step. Review denials weekly from January through at least March, and share patterns with your payor reps.
Clinical leads and BCBAs: documentation is the hinge
The 97155 split is the biggest clinical change. Every session where a BCBA works with a Patient now needs a note that makes clear whether the QHP was directing a technician (still 97155, always reported with the technician's code) or treating the Patient directly (now 97173).
A practical way to prepare: pull a sample of recent 97155 notes and ask of each one, was the BCBA directing an RBT with the Patient present, or working with the Patient 1:1? That sample will show you roughly how your 97155 hours will split between the two codes, and it's a useful conversation to have with your billing lead before January.
The Coalition’s supplemental guidance walks through a sample 26-week authorization where 312 units of 97155 split into 208 units of 97155, 104 units of 97173, and 52 new units of 97180. Your numbers will look different depending on how your QHPs spend their time, but running the exercise on a few real authorizations will give you a working estimate before January.
For 97180, start logging the minutes now, even before payors confirm coverage. Data review, protocol updates, discharge planning, and technician training are all activities your BCBAs already do. Getting in the habit of tracking them per Patient will make the weekly reporting feel natural by January.
One more thing: updating a protocol at your desk while an RBT runs a session is 97180 time, not 97155 time. The codes are defined by who is in the room with the Patient, and that distinction needs to be clean.
Billing leads and admins: add-ons, weekly lines, and authorization mapping
Add-ons
+97149 and +97160 go on the claim only with their base codes (97148 and 97159), for the third through fifth technician.
97155
It never goes out alone anymore. It's always reported alongside the technician's code.
97180
One weekly line per Patient, built from that week's total time. This will be a new line item for most practices.
Authorizations
Pull every authorization that lists 97155, 0362T, or 0373T and check the end dates against January 1. Ask each payor how it will handle conversions. Authorizations with 2026 dates of service stay on the old codes. The T-codes are the hard cutoff: no reporting after January 1 regardless.
Modifiers and edits
Watch for same-day or bundling edits among 97155, 97173, and the technician codes. HM, HN, HO, and HP are commonly used with these ABA insurance codes, so confirm modifier requirements with each payor.
Rates
Add new code rates payor by payor, as each one confirms. Don't assume a payor's rate for 97155 will carry over to 97173 or 97180.
RBTs/technicians: record who was in the session and what you delivered
Technicians don't choose the code, but the session note backs it up.
Note who was in the session: which technicians, whether a BCBA joined, and what each person did. If your BCBA spent part of the session directing you and part of the session working with the Patient independently, that matters for coding.
Deliver the protocol as written, and flag anything that needs adjusting for your BCBA.
Know how harmful behavior sessions are set up. Sessions coded as 97148 or 97159 require a customized environment and a QHP on site. If a second technician steps into a regular session when behavior escalates, let your BCBA and billing lead know so they can determine how it should be documented and coded.
How Motivity is built for code transitions like this
Deciding which code fits a service is your call, made with the CPT codebook and your payors. Once you’ve made that call, the operational side (updating authorizations, moving appointments, holding claims while payors catch up) is where your practice management software either helps or gets in the way.
A payor that adopts the new codes on January 1 can run on them while another payor that’s still honoring old authorizations stays on the old ones, all inside the same system. You don’t need a company-wide cutover date, which matters a lot when you’re juggling five different payor timelines at once.
A few things in Motivity are built for this kind of moment.
- Seeing which authorizations are affected. You can sort your Patient Authorization Report to see every authorization that includes 97155, 0362T, or 0373T, with end dates. Then, you can run the same report after you’ve made changes to confirm everything lines up.
- Holding claims while you wait on a payor. Our billable/non-billable toggle prevents claims from going out while a payor’s timeline is still unclear. Compliance and billing rules still run on held appointments, so if something doesn’t match, you’ll see it before the claim is submitted. Once the payor confirms, you can flip them back on.
- Moving appointments in bulk instead of one at a time. You can move Patient’s appointments to the new service code and authorization for whatever date range you set. One transfer covers all of a Patient’s eligible appointments in that range, so you’re not editing sessions individually. If a payor later asks for corrections on appointments that already went out, you can also handle those retroactively.
- Documenting against the right code from day one. Motivity already has session note templates built for the 2027 code set so that your notes are more likely to support the code your biller picks.
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Frequently Asked Questions
Do payors have to use the new ABA billing codes on January 1?
Under HIPAA, health plans have to accept the CPT code set, but the law doesn't set a universal adoption timeline. Coverage decisions, rates, and authorization rules are each payor's call. The one exception is codes 0362T and 0373T: those two should be deleted for all dates of service starting January 1, 2027.
What is the difference between the 97155 and 97173 codes in ABA?
97155 is a qualified health practitioner directing a technician while both are face-to-face with the Patient, and it's always reported alongside the technician's code. 97173 is a qualified health practitioner treating one Patient face-to-face without a technician delivering the service, and it includes analysis of whether the protocol needs adjusting.
What is the difference between the 97153 and 97173 codes in ABA?
97153 is a technician implementing a treatment protocol face-to-face with the Patient. 97173 is a qualified health practitioner treating one Patient face-to-face, analyzing whether the protocol needs adjusting, and making changes as needed. The provider's credentials and the clinical analysis is what distinguishes 97173.
Can I still bill 0362T and 0373T in 2027?
No. They cannot be reported for dates of service on or after January 1, 2027. Services delivered in 2026 stay on the old codes. 97148 (with +97149) replaces 0362T, and 97159 (with +97160) replaces 0373T.
What time counts toward 97180?
Only time the qualified health practitioner personally spends on the five activities in the descriptor, for a specific Patient: reviewing and analyzing data and session notes, deciding whether to modify targets or protocols and making those modifications, deciding whether additional assessment is needed and developing or modifying protocols, developing a discharge or transition plan, and training technicians on treatment targets and implementation.
It's reported in 15-minute units once per week for each Patient. It cannot be reported on the same day as 97151 for the same Patient.
Do I need to update authorizations that are already active?
Check each end date against January 1, 2027. If an authorization runs past that date, ask the payor whether it will require a new authorization or accept mapped codes on the existing one. Authorizations that list 0362T, 0373T, or 97155 need the closest attention. Appointments with 2026 dates of service stay on the old codes.
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This article is general information, not billing, coding, or legal advice. Confirm code selection, documentation, modifiers, and timing with the official CPT codebook and each payor. Payor policies and CMS rules may change after publication.
Sources:
- American Medical Association, CPT 2027 code set release (September 9, 2026)
- ABA Coding Coalition, 2027 CPT Code Crosswalk (September 11, 2026)
- ABA Coding Coalition, Supplemental Guidance on Interpreting and Applying the 2027 CPT Codes for Adaptive Behavior Services (October 2026)
- ABA Coding Coalition, Suggestions for Providers, with template letter to payors (October 2026)
