What is CPT code 97155? A Detailed Billing and Documentation Guide for BCBAs

Among all ABA CPT codes, few cause as much confusion as CPT code 97155. It sits between direct treatment and clinical oversight, which makes it easy to misuse and even easier for payers to question.

For BCBAs, 97155 is not just another billing option. It represents clinical decision-making in action. When billed and documented correctly, it supports treatment quality, protects reimbursement, and demonstrates medical necessity. When billed incorrectly, it becomes a common trigger for denials, audits, and recoupments.

“Accurate billing and documentation are not just about reimbursement, they’re about ethical practice and supporting client progress.” — ABA Billing Expert

What is CPT code 97155?

Before you can use CPT code 97155 correctly, you need to understand exactly what it represents. This isn't just administrative paperwork, it's billing for some of your most valuable professional services.

The Official 97155 CPT Code Description

According to the American Medical Association (AMA), the 97155 CPT code description is

"Adaptive behavior treatment with protocol modification provided by a physician or other qualified health care professional while the patient is present. This service may include simultaneous direction of a technician face-to-face with the patient and is billed in 15-minute units."

If you’re unsure whether your sessions truly match this definition, or you’re seeing denials even when the work is correct, that usually means the billing details or the documentation wording needs a small fix. That’s often the fastest way to protect both compliance and reimbursement. Read More About CPT codes.

How to bill CPT code 97155 correctly

Billing CPT code 97155 goes smoothly when your time, provider role, and note all point to the same thing: active protocol modification with the client present. Most denials happen when 97155 reads like supervision or planning.

Key billing steps:

Verify coverage and prior authorization

• Before billing, confirm that the payer covers CPT 97155 and check whether prior authorization is required.

• Also review unit limits, age restrictions, and any telehealth rules tied to ABA therapy CPT code 97155, since these can vary by plan.

Match units to exact time

CPT 97155 is billed in 15-minute units. For example, a 45-minute session equals 3 units. Make sure your documentation includes accurate start and stop times that match the number of units billed. Mismatched time is a common reason for units exceeding time denials. Know more about this 8-minute rule guide helps to avoid units exceeding time denials.

Confirm provider eligibility

• Only bill CPT code 97155 when the service is provided by a BCBA, licensed behavior analyst, or another qualified professional accepted by the payer.

• Double-check that the provider’s enrollment, taxonomy code, and NPI are correctly set up with each insurance plan.

Avoid common billing errors

• Do not bill 97155 for chart reviews, plan writing, or meetings without the client present.

• Do not use it as a catch-all for supervision unless protocol changes are clearly documented.

• Some payers allow CPT 97155 via telehealth, but modifier and platform rules vary; always confirm payer guidelines first.

When Should You Use CPT Code 97155?

97155 should be used when the client is present, and the BCBA is actively making changes to the treatment protocol during the session, based on what they observe and what the data shows.

• Adjusting Behavior Plans: Use 97155 when the current plan is running, but something needs to be changed right away to keep the session effective.

• Changing Prompt Hierarchy: Use 97155 when the BCBA actively modifies the prompt hierarchy during the session to support learning and independence.

• Real-Time Data Decisions: Use 97155 when the BCBA reviews session data and decides the teaching approach needs to change right now to support progress.

Most Common Mix-Ups

97155 vs 97153

CPT code 97153 is used when the RBT is doing the treatment plan with the client. 97155 is used when the BCBA is changing or updating the plan while the client is there. Both can sometimes be billed at the same time, but you must check each payer’s rules. 

Avoid overlapping 97155 with 97153 unless the payer allows it and time is clearly separated. For detailed guidance, see this CPT code 97153 billing guide.

97155 vs 97156

CPT code 97156 is used when the main goal is teaching or guiding the parent or caregiver. Use 97156 if the session is mostly parent coaching. Use 97155 if the main goal is changing the client’s treatment plan while the client is present.

97155 vs 97151

CPT code 97151 is used for assessment or reassessment, like when you are figuring out needs and building the plan. 97155 is used after the plan is already in place, when you are making changes to improve it based on what you see and the data.

Documentation guide on CPT code 97155

For CPT code 97155, your note should quickly show why the plan needed a change and what you changed. Include the time, location, who was present, the data reason, the exact protocol update, what you did with the client/RBT, how the client responded, and the next steps. Clear notes help 97155 claims get approved. If you want stronger language and formatting, see how to write better ABA session notes with real examples.

A Realistic Documentation Example (97155)

Service: CPT 97155 – Adaptive behavior treatment with protocol modification (BCBA)Date/Time: 01/09/2026, 2:00–2:45 PM (45 minutes, 3 units)Location: ClinicProvider: Smith, BCBAPresent: Client (J), RBT (Alex), J’s mother for a brief update at the start of the session

Reason for Protocol Modification

When you look back at the last three RBT-led sessions, one thing stands out: J’s independent tacting actions have leveled off at 55–60%. The RBT and caregiver also reported more escape-type whining during table work, happening in about 40–50% of trials.

During today’s session, the BCBA observed the RBT run the program to confirm treatment integrity, then modified the protocol in real time. Prompting was shifted to most-to-least for early trials and faded as J improved. Reinforcement was updated so that independent responses earned a stronger reward than prompted responses, and a brief preference check was added to prevent quick satiation. 

After these changes, J’s independent correct responses increased to about 75%, whining dropped, and engagement improved. This supports the 97155 CPT code description and proper use of CPT code 97155.

FAQ

1. What is the 97155 CPT code description?

The 97155 CPT code description refers to adaptive behavior treatment with protocol modification, delivered by a BCBA while observing the client and adjusting the treatment plan in real time.

2. Can you bill 97155 without a client present?

No. CPT code 97155 requires the client to be present. If the client is not present and the session focuses on caregiver training, bill CPT code 97156 instead.

3. What is the difference between CPT 97153 and 97155?

CPT 97153 covers direct treatment delivery. CPT 97155 is used when a BCBA observes the client and modifies treatment protocols based on data during the session.

Conclusion

CPT code 97155 is not just a billing tool. It is a clinical accountability code that reflects expert-level decision-making in applied behavior analysis. For BCBAs, mastering the 97155 CPT code description, billing rules, and documentation standards is essential for sustainable practice growth and compliance.

If you’re new to the billing process or want to understand how sessions turn into paid claims, book a call with us and let us help you clear the headaches and move forward with confidence.