June 1 Applied Behavior Analysis Rate Update

Friday, June 9, 2023

The Defense Health Agency (DHA) posted updated applied behavior analysis (ABA) rates June 1, 2023. Rate changes affect dates of service on or after June 1, 2023. 

Changes include:

• Revised provider type titles
• Alignment of Current Procedural Terminology (CPT®) codes 99366 and 99368 rates with CHAMPUS Maximum Allowable Charge (CMAC) rates, available at www.health.mil/CMAC 

How do I look up rates for CPT codes 99366 and 99368?

Effective June 1, 2023, rates for CPT codes 99366 and 99368 are no longer listed in the “Applied Behavior Analysis Maximum Allowed Amounts” section of www.health.mil/rates. Instead, providers billing for ACD-related medical team conferences with CPT codes 99366 (beneficiary or parent/family present) and 99368 (beneficiary or parent/family not present) can find current rates at www.health.mil/CMAC.

When searching for CMAC rates:

1. Enter your location details in “Step 1 – Identify the Locality.”
2. Enter the procedure code in “Step 2 – Identify Procedure Code(s)” and click “Submit.”
3. Look in the “Non-Physician”/ “Non-Facility” column for rate information. 

Balance Billing Reminder

ABA providers may not bill the beneficiary more than 100% of the rates posted on DHA's Applied Behavior Analysis Maximum Allowed Amounts page. The balance billing guidelines defined in the TRICARE Reimbursement Manual (Chapter 3, Section 1, paragraph 4.0) do not apply.