New Insurance CPT Codes for ABA: Horizon Meets with Autism New Jersey and Providers

On January 1, 2019, new CPT codes issued by the American Medical Association for billing applied behavior analysis (ABA) services to health plans became effective. To assist providers through this transition, Autism New Jersey compiled some helpful documents  and hosted a meeting with representatives from Horizon Blue Cross Blue Shield of New Jersey to discuss implementation of the new CPT codes.

To open the meeting, Autism New Jersey provided an overview of earlier collaborations with Horizon BCBSNJ to note accomplishments and address challenges. Horizon BCBSNJ then shared information about how they are transitioning to the new codes and the resulting changes in their processes. Next, several provider organizations spoke about their challenges, and everyone brainstormed ways to improve the process. Throughout the meeting, providers presented a variety of issues that they have been experiencing with the new codes, and the representatives from Horizon BCBSNJ were open and amenable to looking for solutions to ensure that individuals with autism are receiving the highest quality of care.

The meeting adjourned with the group agreeing to meet on a regular basis for the next few months to continue the dialogue and problem-solving process. We would like to thank everyone in attendance for such a productive start to an essential dialogue to fulfill the intent of the autism insurance mandate on behalf of children and adults with autism.

Helpful Documents

• CPT Codes Crosswalk
• CPT Codes Suggestions for Providers
• CPT Codes Final Update to Constituents – includes information about higher allowable limits on certain codes that are in effect as of January 1st and will not be officially published until April 1, 2019. More specifically, MUEs for a HCPCS or CPT code are the maximum number of units of service a provider would report under most circumstances for a single beneficiary on a single date of service. This memo contains higher MUEs for certain codes and more.
• Association of Professional Behavior Analysts (APBA) webinars on new CPT codes
• The CPT^® 2019 code books, available from the American Medical Association (AMA) Store
• Article in the November 2018 issue of the CPT® Assistant newsletter published by the AMA.
  • To purchase just the November 2018 issue, call 1-800-621-8335, select option 2 in the recorded menu, and ask for item BI506118.
  • The cost is $19.95; $14.95 for AMA members.
• Horizon/Beacon Health Options information for providers
• Cigna information for providers
• Optum/Oxford information for providers – 1
•  Optum/Oxford information for providers – 2