What is CPT code 97156? Key Insights for ABA Therapy Professionals

In Applied Behavior Analysis (ABA), progress does not happen only during direct therapy sessions. Caregiver training is a big part of long-term success, and this is where CPT code 97156 is used. 

CPT 97156 allows providers to bill for caregiver or family training when the patient is not present. However, this code is often misunderstood or used incorrectly. Many ABA practices underbill, face claim denials, or miss revenue because they are unsure how to use CPT code 97156 properly. Understanding how this code works is important for accurate ABA billing, better compliance, and stronger treatment outcomes.

What Is CPT Code 97156?

CPT code 97156 is used when you meet with a parent or caregiver to teach them how to support the child’s ABA goals, without the patient present. Think of it as a caregiver coaching session that helps the child make progress at home, at school, and in the community. It must connect to the treatment plan, not general advice.

97156 CPT Code Description

CPT code 97156 is defined as "Adaptive behavior treatment by protocol, administered by a technician under the direction of a physician or other qualified health care professional, face-to-face with one patient; each additional 15 minutes of technician time."

This ABA therapy CPT code is an add-on code used in conjunction with the primary code 97153. While 97153 covers the first 15 minutes of direct adaptive behavior treatment, 97156 captures each additional 15-minute increment beyond that initial period. Read more about CPT code 97153.

Where 97156 Fits in ABA CPT Codes

97156 is part of the full set of ABA CPT codes. Unlike direct therapy codes, it focuses on training caregivers to use ABA strategies outside of therapy sessions.

How to Bill CPT Code 97156

Billing CPT code 97156 correctly requires attention to detail and adherence to payer-specific guidelines. Here's a step-by-step approach to ensure accurate claims submission:

Step 1: Verify the Initial Code

Before billing 97156, confirm that you've billed the base code 97153 for the first 15 minutes of adaptive behavior treatment. The 97156 code cannot stand alone and must always be accompanied by 97153 on the same date of service.

Step 2: Calculate Time Units Accurately

Time calculation is critical for proper billing. Each unit of CPT 97156 represents 15 minutes of direct treatment time:

• 30 minutes total = 1 unit of 97153 + 1 unit of 97156

• 45 minutes total = 1 unit of 97153 + 2 units of 97156

• 60 minutes total = 1 unit of 97153 + 3 units of 97156

Apply the midpoint or 8-minute rule as required by your payer. If you need a reminder, our 8-minute rule cheat sheet explains it clearly.

Step 3: Use Proper Modifiers

Depending on the payer and service circumstances, you may need to append modifiers to CPT 97156:

• Modifier 59: Distinct procedural service (when billing multiple services on the same day)

• Modifier XE, XP, XS, XU: More specific versions of modifier 59, required by some payers

• Telehealth modifiers: If delivering services via telehealth (check payer policies)

Step 4: Submit with Complete Documentation

Your claim should include:

• Patient demographics and insurance information

• Correct diagnosis codes (typically from the F84 series for autism spectrum disorders)

• Date and location of service

• Provider credentials (NPI numbers for both rendering and supervising providers)

• Total units of service

• Any required prior authorization numbers

Step 5: Monitor CPT Code 97156 Reimbursement

Track your CPT code reimbursement rates across different payers. Reimbursement can vary significantly based on:

• Geographic location

• Payer contract terms

• Patient's specific plan benefits

• Whether services are in-network or out-of-network

Most commercial payers reimburse 97156 at rates ranging from $15 to $35 per unit, though this varies widely by region and contract.

When to Bill CPT Code 97156

Knowing when to use 97156 versus other ABA CPT codes is essential for compliance and optimal reimbursement. Bill uses CPT code 97156 when you provide face-to-face caregiver guidance, and the client is not present, in 15-minute units, tied to treatment plan goals.

Don’t bill it for admin time, assessment work, direct client treatment, or BCBA supervision. Use the correct ABA billing codes instead to protect CPT code reimbursement.

Documentation requirements of CPT code 97156

Proper documentation is the foundation of successful billing for CPT code 97156. Insurance audits and claim denials often stem from inadequate or missing documentation. 

Example Documentation Excerpt

Instead of vague notes like:

“Provided parent training on behavior strategies.”

Use detailed, defensible language:

“Provided 45 minutes of caregiver training focused on implementing differential reinforcement strategies for task refusal. Reviewed data trends, modeled response procedures, and coached caregiver through role-play scenarios. Caregiver demonstrated understanding and asked relevant follow-up questions. Service supports treatment generalization and reduction of maladaptive behaviors in the home setting.”

For more guidance on writing ABA session notes that hold up during audits, see how to write better ABA therapy documentation.

CPT Code 97156 vs. Other CPT Codes in ABA Therapy

Confusion often arises between CPT 97156 and other CPT codes ABA professionals use daily. The most common mix-ups occur with 97155 (Protocol Modification) and 97157 (Group Guidance). For broader comparisons across ABA services, the ABA code conversion table helps clarify billing decisions quickly.

Below is a comparison table to clarify the distinctions.

Key Distinction: 97156 vs. 97155

The difference is patient presence and session intent. If the BCBA observes the client and modifies the plan, bill 97155. If parent education is only without the client, bill 97156.

How We Help While Dealing with These ABA Billing Codes

ABA billing codes can get messy fast, especially when you’re tracking units, supervision rules, authorizations, and payer quirks by hand. Cube takes that pressure off. We help you bill CPT code 97156 correctly with tighter documentation, unit checks, and real-time authorization tracking so you don’t overrun limits.

Our team also watches denials, fixes coding errors early, and keeps credentialing and supervision records clean, which protects CPT code reimbursement. The result is fewer reworks, faster claims, and clearer visibility into what’s getting paid across your ABA CPT codes.

FAQ

1. What is the 97156 CPT code description?

CPT 97156 covers caregiver training on behavior strategies tied to the treatment plan, provided by a qualified clinician, when the client is not present.

2. Can 97153 and 97156 be billed together?

Sometimes, yes. Bill both only when services are separate and clearly documented, not overlapping. Always follow payer rules and authorizations.

3. Is CPT 97156 reimbursed by Medicaid?

It depends on the state Medicaid plan and provider manual. Many cover it with authorization, but coverage, limits, and modifiers vary widely.

Conclusion

CPT code 97156 is not an optional add-on or a secondary service. It is a core component of high-quality ABA care when used correctly. For ABA therapy professionals, understanding how to bill, document, and justify this code ensures compliance, protects revenue, and strengthens treatment outcomes beyond the therapy room.