CPT Code 97155: Adaptive behavior treatment with protocol modification

When to Use CPT 97155

Use CPT code 97155 when billing for adaptive behavior treatment with protocol modification. This code is used by licensed therapists (LCSW, LPC, MFT, Psychologist) for outpatient sessions.

Adding CPT 97155 to a Superbill

When generating a superbill with CPT 97155, include the ICD-10 diagnosis code, date of service, fee charged, amount paid, and your NPI number. Superbilled pre-fills common therapy CPT codes automatically.

Common ICD-10 Pairings

These diagnosis codes are frequently used alongside CPT 97155:

Documentation Requirements

Document the specific protocol modifications made and clinical rationale. Must be administered by a BCBA directly working with the patient.

Common Denial Reasons

• ✗ Protocol modification not performed by a BCBA
• ✗ Missing documentation of what protocols were modified and why
• ✗ Excessive BCBA direct hours relative to technician hours

Reimbursement Expectations

OON reimbursement typically 40-60% of UCR. Expect $40-$120 per hour.