1st Edition
CPT Codes in ABA Services in Plain English How to Avoid Fraudulent Billing
Part 1: Clinical Questions about CPT Codes and the BACB's Ethics Code
Chapter 1: How can BCBAs Ethically Determine the Number of Dosage Hours Clients Need for Effective Treatment?
Chapter 2: How do I communicate with third party stakeholders, and ABA business leaders, about ethical billing activities?
Chapter 3: How Do I Begin the Process for Insurance funding to cover ABA Therapy using CPT Codes?
Chapter 4: Which Services are Covered by Insurance for an ABA Assessment?
Chapter 5: How do BCBAs request approval from Insurance Providers for ABA Therapy Services?
Chapter 6: How can Unrestricted Activities be Counted to Meet the BACB's 60% Allowable Criteria for Supervision During Direct Therapy Sessions Using CPT Codes?
Chapter 7: Which CPT Codes can be Used for Structured Activities and Child-led Activities?
Chapter 8: Should a BCBA Sign a Progress Note (SOAP Note) Written by an RBT Even if the BCBA was not Present During the Therapy Session?
Part 2: Clinical Questions About Medical Necessity, CPT Codes, and BACB's Restricted and Unrestricted Activities
Chapter 9: Are Restricted and Unrestricted Activities included in CPT Codes?
Chapter 10: How Should a BCBA Respond to Insurance Denials for Patient Assessments, Treatments and Dosage Recommendations?
Chapter 11: How Long Should it Take for a BCBA to Write an Assessment Report aka Treatment Plan?
Chapter 12: What is the Difference Between Inpatient and Outpatient Services?
Chapter 13: Can a BCBA and RBT Bill for Writing SOAP Notes?
Part 3: Clinical Questions about CPT Codes, BCBAs, RBTs and Parent Trainings
Chapter 14: Does every insurance company require behavior technicians to be RBT credentialed and is there a grace period?
Chapter 15: Is There a CPT Code for RBTs to use When Assisting with Functional Behavior Assessments and Developmental Assessments?
Chapter 16: Do CPT Codes Allow for Parent Training Curriculums?
Chapter 17: Do CPT Codes Allow for BCBAs to Provide all Types of Therapeutic Activities with Patients and Parents?
Chapter 18: Can BCBAs use Behavior Skills Training (BST) When Training RBTs and Parents Using CPT Codes?
Chapter 19: How is the 8-minute Rule Applied to a Billable Hour and CPT Codes?
Chapter 20: Is There a Billing Modifier Code Used When One or More RBTs Works With the Same Client?
Chapter 21: How Many Hours can a BCBA Bill Insurance for Parent Training if the Parents do not Implement Treatment Plans?
Chapter 22: How should a BCBA respond to a RBT who has gone 'rogue' with billing and CPT Codes?
Biography
Tina Guidry is a Board Certified Behavior Analyst (BCBA) with 25 years of experience leading research‑based behavior‑change initiatives, publishing studies, and training professionals to improve outcomes for clients in educational and community settings.
“This book is a must read for Board Certified Behavior Analysts who want to understand the business side of ABA and remain compliant with the BACB Code. It lays out the most critical issues facing BCBAs in clear, easy-to-understand guidance. Having run an ABA clinic for over 15 years as a compliance attorney, I find this book essential reading for all BCBAs.”
Maria Cammarata, MEd, Attorney at Law, Cammarata & Cammarata, P.L.
"Clear, practical, and grounded in real-world experience, this book delivers essential guidance on preventing fraudulent billing while maintaining ethical, sustainable practice. It bridges compliance, clinical integrity, and leadership in a way that is both accessible and authoritative, an invaluable resource for ABA providers and practice owners."
ReAnne Woods, MS, BCBA, LBA, Founder & CEO, ABC Behavior Therapy LLC
"ABA has grown exponentially, at a cost to ethical service delivery. This book is a necessary manual for business leaders and ABA therapists alike. Drawing from decades of research-based evidence and human insight, Tina distills this into practical applications for everyday implementation. This book should be compulsory reading for everyone in the field."
Kelly Taylor, BSc (hons), BCABA and Adv Dip Integrative Psychotherapy ABA Matters, UK
"Tina’s expertise and real-world experience make this an engaging and educational book. This book offers a clear insight into the world of insurance and billing for ABA therapy. It is packed with practical and proven strategies and is a must read for anyone with a career in this field.
Sarah Saxton, MA, BCBA, Chief Clinical Officer and Founder, Milestones Autism Center
“With impressive scope and clarity, CPT Codes in ABA Services in Plain English shows BCBAs exactly how to connect assessment, treatment planning, and documentation to CPT codes while staying firmly grounded in medical necessity and the BACB Ethics Code. The result is a rare blend of clinical rigor and billing know-how that every ABA therapist, clinical director, and agency owner should keep within arm’s reach.”
Thomas DeCarli, MA, BCBA, Owner of Pillar 5
