A few weeks after ABA starts, your health plan begins mailing (or posting online) Explanations of Benefits, or EOBs. They are full of five-digit codes, units and dollar amounts. Reading them is worth the effort: the EOB is how you check that what was billed matches what your child received, and how you track your deductible. This guide decodes the ABA codes and shows you what to look for.
What is an EOB, and is it a bill?
An EOB is not a bill. It is the plan's statement of how it processed a claim. A typical EOB line shows:
- Date of service and the provider who billed.
- Procedure code (the CPT code) and the number of units.
- Billed amount: what the provider charged.
- Allowed amount: what the plan recognizes for that service. For in-network providers, this is the contracted rate.
- Plan paid and your responsibility (deductible, copay or coinsurance).
- Remark or reason codes explaining any denial or adjustment, with a key on the back or online.
Your provider's bill should match the "your responsibility" amount on the EOB for the same dates. If you have two plans, each one sends its own EOB; see coordination of benefits.
What do the ABA codes 97151 to 97158 mean?
The American Medical Association (AMA) maintains the CPT code set. The adaptive behavior codes cover services that address "deficient adaptive behaviors, maladaptive behaviors, or other impaired functioning," with examples such as communication, play, social interaction, self-care, daily living and personal safety. The descriptions below summarize the AMA's long descriptors (in use through 2026), with the short label that appears in the federal code files published by CMS, which is often what prints on an EOB.
| Code | Short label on many EOBs | What it means | Who delivers it |
|---|---|---|---|
| 97151 | Bhv id assmt by phys/qhp | Behavior identification assessment: time face to face with your child and you giving assessments and discussing results, plus time analyzing data, scoring and writing the report and treatment plan. Each 15 minutes. | A physician or other qualified health care professional (in ABA, usually a BCBA) |
| 97152 | Bhv id suprt assmt by 1 tech | Supporting assessment, face to face with your child, each 15 minutes. | One technician (such as an RBT) under the professional's direction |
| 97153 | Adaptive behavior tx by tech | Adaptive behavior treatment by protocol, face to face with one patient, each 15 minutes. This is the typical therapy session. | A technician under the professional's direction |
| 97154 | Grp adapt bhv tx by tech | Group treatment by protocol, face to face with two or more patients, each 15 minutes. | A technician under the professional's direction |
| 97155 | Adapt behavior tx phys/qhp | Treatment with protocol modification, face to face with one patient, "which may include simultaneous direction of technician," each 15 minutes. | The physician or qualified professional (BCBA) |
| 97156 | Fam adapt bhv tx gdn phy/qhp | Family adaptive behavior treatment guidance, face to face with parents or caregivers, with or without your child present, each 15 minutes. This is parent training. | The physician or qualified professional (BCBA) |
| 97157 | Mult fam adapt bhv tx gdn | Multiple-family group guidance, without the patients present, each 15 minutes. | The physician or qualified professional |
| 97158 | Grp adapt bhv tx by phy/qhp | Group treatment with protocol modification, face to face with multiple patients, each 15 minutes. | The physician or qualified professional |
| 0362T, 0373T | Bhv id suprt assmt ea 15 min; Adapt bhv tx ea 15 min | Temporary (Category III) codes for assessment and treatment of a patient who "exhibits destructive behavior," with the professional on site and two or more technicians, in a setting customized to the patient. Each 15 minutes of technicians' time. | Two or more technicians with the professional on site |
For terms such as BCBA, RBT and protocol, see the ABA glossary for parents.
How do units work?
Each ABA code is billed per 15 minutes, so one unit equals 15 minutes. Here is an example only, to show the math; your child's schedule and billing will differ:
- A 3-hour session with an RBT could appear as 97153 x 12 units.
- If the BCBA joined for 1 hour of that session to adjust the program, you might also see 97155 x 4 units on the same date.
- A 1-hour parent training meeting could appear as 97156 x 4 units.
Seeing 97153 and 97155 on the same day is not automatically an error. The AMA descriptor for 97155 allows the professional to direct the technician at the same time. Plans set their own rules on how much of this they authorize; Aetna's ABA guide, for example, says additional authorization may be provided for protocol modification and direction "at 1 to 2 hours per 10 hours of treatment by protocol", and Cigna's Evernorth policy uses a similar ratio. Check your authorization letter, which lists the codes and units approved for each period.
How do I spot a billing error on my EOB?
Compare each EOB with your own calendar and the provider's session notes or schedule. Look for:
- Dates your child did not have a session, such as a cancelled day, a holiday or a sick day.
- Units that exceed the session length. A 2-hour session is 8 units, not 10.
- The wrong code, such as 97155 on a day the BCBA was not there, or 97156 when no parent training happened.
- Duplicate lines for the same date, code and units.
- Services after the authorization ended, which the plan may deny.
- The wrong family member, especially if siblings are both in services.
- Out-of-network processing for a provider you were told is in network.
Small mismatches are often clerical, so start with the provider. Ask the billing office for an itemized statement and explain what does not match. If it is not resolved, call the plan's member services number and ask them to review the claim. Our guide to fixing ABA insurance billing problems has step-by-step help. State of Florida employees on the State PPO have a Patient-Auditor Program that can share recovered overcharges; see the state employee plan guide.
What do common EOB messages mean?
- Applied to deductible: the plan approved the service but you pay the allowed amount until your deductible is met. Common early in the plan year.
- No authorization on file: the units fall outside the approved authorization, or the authorization had not been entered. Call the provider first; this is often fixable.
- Exceeds units authorized: more units were billed than approved for that period.
- Coordination of benefits / other insurance: the plan thinks another plan should pay first. Update your other-insurance information with both plans.
- Not a covered benefit: the plan does not cover the service under your policy. Ask for the plan language and see appealing an ABA denial.
If the plan has contested or denied a provider's claim in a fully insured Florida plan, s. 627.6131(9) says the provider may not try to collect from you for the covered service while the claim is in the insurer's internal dispute process (up to 60 days), apart from your copay, coinsurance or deductible.
What changes in January 2027?
In its September 2025 summary of panel actions (updated October 24, 2025), the AMA's CPT Editorial Panel recorded an accepted change to adaptive behavior services: the addition of new codes, "revision of codes 97151-97158," revised guidelines and "deletion of codes 0362T, 0373T," effective January 2027. In practice, EOBs for 2027 dates of service may show new codes or revised descriptions, and authorization letters may change format. Your plan and provider will tell you what applies to your child; the codes in this guide describe services through December 2026.
How Hope Center can help
If anything on an EOB does not make sense, call us. Hope Center for Behavior Change will walk through the codes and units with you, compare them with your child's schedule and correct any error on our side. We also explain your likely share of costs before services start through a free benefits check. Costs depend on your plan; self-pay with a sliding scale is available. See insurance at Hope Center, contact us, or call 561-337-8865.