ABA Telehealth Coverage Post-COVID
During the COVID-19 public health emergency, most payers expanded telehealth coverage for ABA services. Many states passed permanent telehealth parity laws requiring commercial insurers to reimburse telehealth ABA services at the same rate as in-person services.
Telehealth Modifiers
- Modifier 95 — Synchronous real-time audio/video. This is the standard telehealth modifier for ABA.
- Modifier GT — Via interactive audio and video telecommunication systems. Used by Medicare/Medicaid; less common for commercial ABA.
- Modifier FQ — Audio-only telehealth (limited coverage; check payer policy)
Place of Service for Telehealth
- POS 02 — Telehealth provided to patient in their home
- POS 10 — Telehealth provided to patient not in their home
- Note: Some payers still accept POS 11 for telehealth; verify per payer
Which ABA Codes Are Telehealth-Eligible?
Typically eligible via telehealth (payer-dependent):
- 97151 — Assessment (provider telehealth)
- 97155 — BCBA direct treatment
- 97156 — Caregiver training (most telehealth-friendly ABA code)
Often NOT covered via telehealth:
- 97153, 97154 — Many payers exclude RBT-delivered direct treatment via telehealth (hands-on prompting not possible)
Consent and Documentation Requirements
- Obtain and document patient/guardian consent for telehealth services
- Document the platform used (HIPAA-compliant video conferencing required)
- Record the patient's location at start of session
- Note that services were provided via telehealth in session notes
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