Additional Autism Services Allowed as Telehealth

Starting August 21, 2024, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will begin reimbursing additional behavioral health inpatient and outpatient services performed via Telehealth visits. The updated Telehealth Reimbursement Policy reflecting these changes will be updated and posted on August 21, 2024 on our Medical Policies and Guidelines page.

These additional behavioral health service codes, defined below, include adaptive behavior treatment for autism spectrum disorders and are in addition to the existing behavioral health codes.  The appropriate telehealth place of service, procedure code and modifier combination are required for reimbursement.

97153 - Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional

97155 - Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous direction of technician,

This policy applies to Commercial, IPP Host and Federal Employee Program (FEP). This will not apply to IPP Home, Medicare Advantage and Experience Health