Individual vs. Group ABA Therapy Billing: What You Really Need to Know

Same child. Same week. Same goals. One claim paid. One denied.

The difference wasn’t the therapy, it was how it was billed.

Individual and group ABA therapy aren't just clinically different, they're billed using completely different codes, require distinct documentation, follow separate rules, and face unique compliance challenges.

This guide breaks down everything you need to know about individual vs. group ABA therapy billing, how to choose the right codes, document correctly, and submit claims that hold up under payer review.

Understanding ABA Therapy

ABA therapy is a structured, evidence-based approach that helps people learn useful skills and improve everyday behaviors. It uses simple, data-based methods to encourage positive actions and reduce behaviors that affect daily life.

• Goals and Techniques: Interventions are tailored to the individual, using techniques like positive reinforcement to encourage desired outcomes.

• Populations Served: primarily children and adults with autism, but also those with other developmental disorders.

Types of ABA Therapy

• Individual Therapy: A technician works one-on-one with a client.

• Group Therapy: A technician works with two or more clients simultaneously, often facilitating social interaction.

Individual ABA Therapy Billing

Individual therapy is the cornerstone of most ABA programs. It allows for intensive, focused teaching trials tailored to the client's unique learning style.

• Structure: Direct 1:1 engagement.

• Session length usually runs 1 to 4 hours, based on the client’s medical necessity and the goals targeted that day.

Billing Practices for Individual Therapy

To ensure reimbursement, providers must use the correct applied behavior analysis CPT codes.

• CPT Code Used: The standard CPT code 97153 is used for adaptive behavior treatment by protocol, administered by a technician (RBT) face-to-face with one patient.

• Documentation: Notes must detail the specific interventions used and the client's response.

• Insurance: Most plans cover CPT 97153 readily when medical necessity is established.

Group ABA Therapy Billing

Group therapy helps clients use their skills in social situations. It allows them to practice communication, taking turns, and managing emotions with peers.

Billing Practices for Group Therapy

Knowing how to bill for group therapy is crucial for compliance, as errors in this area are common.

• CPT Code Used: The primary CPT code 97154 covers group adaptive behavior treatment by protocol, administered by a technician face-to-face with two or more patients.

• Medicare Group Therapy Rules: According to federal guidelines, including those of Medicare, group therapy involves treating two or more patients simultaneously. You cannot bill CPT 97153 for multiple clients at the same time; you must switch to the 97154 CPT code.

• Documentation: Records must reflect the group dynamics and specific goals addressed for each participant.

Individual vs. Group ABA Billing: Side-by-Side Comparison

Let's compare the two codes directly to highlight the key differences.

Factor	Individual (97153)	Group (97154)
Number of clients	One client per session	Two or more clients simultaneously
CPT code	97153	97154
Billing calculation	Session duration ÷ 15 minutes	Session duration ÷ 15 minutes (Not multiplied by number of clients)
Typical reimbursement	Higher Rate (Per Unit)	Lower Rate (Per Unit/Patient)
Documentation burden	Moderate	High (Roster + individualized targets/data)
Rendering provider	RBT with own NPI	RBT with own NPI
Billing clarity	Usually straightforward	Often questioned if notes are generic
Common settings	Home, clinic, school, community	Clinic, school, community (Less common in the home)

Important Considerations for Providers

For ABA billing companies and clinics, small billing details can decide whether a claim gets paid or denied. Even when therapy is delivered correctly, mistakes on the back end can cause delays, denials, or audit risk.

Rendering provider meaning

The rendering provider's meaning is straightforward. The rendering provider is the person who actually delivered the service, usually the RBT. The billing provider is the agency or clinic that submits the claim.

Both must be listed correctly. If the rendering provider does not match the session note, payers may deny the claim or request records. This is not optional. It is a legal billing requirement. Read More About rendering providers.

RBT NPI number

Many payers require an RBT NPI number when the RBT is listed as the rendering provider. Clinics should regularly check that:

• Each RBT NPI number is active

• The NPI is correctly linked to the group practice

• The rendering provider on the claim matches the therapist named in the note

Missing or incorrect NPI details are a common reason clean sessions turn into denials.

Navigating Insurance and Billing Issues

Maximize benefits with correct authorization

Authorizations should match how services are delivered. If your clinic provides both individual and group sessions, the authorization should clearly support both ABA CPT codes:

If group services are not authorized, billing CPT code 97154 often results in automatic denial.

Handling denials the right way

When a denial comes in, start with one question: Did the ABA therapy CPT code match the session that occurred?

Common issues include:

• Billing CPT code 97153 when the child was treated in a group

• Billing CPT code 97154 when treatment was not truly simultaneous or not documented per learner

Claims must align with the session model, documentation, and ABA billing codes used. When those pieces match, approvals are far more consistent under the current applied behavior analysis CPT codes. Learn more about CPT Codes

FAQ

1. What is the difference between group billing and individual billing?

Individual billing is 1:1 service using CPT 97153. Group billing uses CPT code 97154 with two learners treated together, documented separately.

2. Can I bill CPT 97153 for two clients at the same time? 

No. CPT 97153 is for one learner per time block. If two clients are treated together, use CPT code 97154 instead.

3. Does Medicare cover group ABA therapy?

Usually no. Under most Medicare group therapy rules, ABA services aren’t covered. Always confirm the plan, because policies can vary by Medicare Advantage carrier.

Conclusion

Understanding the distinction between Individual vs. Group ABA Therapy Billing is vital for the sustainability of therapy practices and the financial well-being of families. Whether you are using CPT code 97153 for focused work or CPT code 97154 for social groups, accuracy is key. 

Are you a provider struggling with ABA billing codes or a family confused by your statement? Contact us today to clarify your ABA billing questions and ensure you are getting the most out of your therapy services.