CPT Code 97158: Group adaptive behavior treatment with protocol modification

When to Use CPT 97158

Use CPT code 97158 when billing for group adaptive behavior treatment with protocol modification. This code is used by licensed therapists (LCSW, LPC, MFT, Psychologist) for outpatient sessions.

Adding CPT 97158 to a Superbill

When generating a superbill with CPT 97158, 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 97158:

Documentation Requirements

Document BCBA-led group protocol modifications, group size, and individual patient data collection. Include rationale for group format with protocol changes.

Common Denial Reasons

• ✗ Protocol modification not performed by a BCBA in the group setting
• ✗ Individual patient data not documented
• ✗ Group size or format does not meet payer criteria

Reimbursement Expectations

OON reimbursement typically 35-55% of UCR. Expect $21-$66 per patient per hour.