Step-by-Step Guide to ABA Therapy Billing

Navigating the ABA therapy billing process can be tricky, especially if you’re new to working with insurance companies. From verifying coverage to managing denials, every step requires precision and follow-up. Below, we’ll walk through a practical, easy-to-follow guide that helps ABA providers streamline billing, reduce claim rejections, and get paid faster. For those who want expert assistance, professional ABA therapy billing services from Pharmbills can manage the process end-to-end.

Step 1: Verify Insurance and Pre-Auth Requirements

Before the first session begins, always confirm a client’s insurance details. Each payer—whether it’s Medicaid, TRICARE, or a commercial plan—has different requirements. Skipping verification can lead to claim denials or delayed payments.

Here’s what you should confirm:

The patient’s coverage status and effective dates.
If ABA therapy is covered under the behavioral health benefit.
Whether pre-authorization is required and for which CPT codes.
Any session limits or supervision rules.
Documentation or referral requirements specific to the payer.

It’s best to keep detailed records of every verification—date, time, representative’s name, and confirmation number. This proof can be helpful when resolving disputes later. Accurate verification ensures your claims align with payer rules right from the start.

Step 2: Document and Code Each Session Accurately

Documentation is the backbone of clean billing. Notes should clearly show what services were provided, by whom, and for how long. Every claim must match its corresponding session note.

Essential details to include in your notes:

Client’s name, date of service, and duration.
Setting (home, clinic, school, or telehealth).
Targeted goals or behaviors worked on.
Provider credentials and signature.

ABA billing uses standardized CPT codes. Here are the most common ones:

97151 – Behavioral assessment by a BCBA.
97153 – Adaptive behavior treatment by a technician.
97155 – Protocol modification or supervision by a BCBA.
97156 – Family adaptive behavior guidance.
97158 – Group adaptive behavior treatment.

Coding errors are among the top reasons for denied claims. Always verify that the time billed matches the CPT code’s requirements and the authorization limits. Double-check modifiers if your payer requires them for supervision or telehealth.

Step 3: Submit Claims and Track Responses

Once documentation and coding are complete, it’s time to submit claims. Depending on your setup, you can use clearinghouses, insurer portals, or integrated billing platforms. Each method has its own advantages:

Clearinghouses (like Availity or Office Ally) simplify multi-payer submissions.
Insurance portals offer real-time feedback but can be time-consuming.
Integrated billing software connects directly to EHR systems for automation.

After submitting, monitor claim status regularly. Don’t assume silence means approval—payers may flag issues without notification. Tracking systems can alert you if claims are rejected or delayed, helping you act before payment deadlines expire.

For best results, schedule weekly reviews of claim reports and follow up on anything older than 30 days.

Step 4: Manage Denials and Resubmissions

Even with a strong billing workflow, denials happen. The key is identifying why they occur and fixing them quickly.

Common denial reasons include:

Missing pre-authorization or expired coverage.
Incorrect or mismatched CPT codes.
Invalid patient identifiers or provider NPI numbers.
Late submission beyond payer deadlines.
Insufficient documentation to prove medical necessity.

When a claim is denied:

Read the payer’s Explanation of Benefits (EOB) carefully.
Correct the issue—update codes, attach missing documentation, or renew authorization.
Resubmit promptly, keeping copies of all correspondence.

Creating a “denial log” helps track trends. If certain payers frequently deny claims for the same reason, you can adjust your verification or coding process to prevent it. Many clinics also automate parts of this workflow using revenue cycle management tools, which reduce human error and shorten resubmission times.

Conclusion

Successful ABA therapy billing depends on accuracy, organization, and consistent follow-up. Each step—from verifying insurance to resubmitting denials—plays a critical role in maintaining a steady cash flow and reducing administrative stress.

For practices that want to focus on clients instead of paperwork, outsourcing can make a big difference. Partnering with experts like pharmbills.com ensures every claim follows payer guidelines, deadlines are met, and reimbursements arrive faster.

In short, ABA therapy billing isn’t just about submitting claims—it’s about building a structured process that protects revenue and supports sustainable growth for your practice.