97151 — Behavior Identification Assessment
Comprehensive behavioral assessment conducted by a qualified healthcare professional (typically a BCBA). Includes clinical observation, data collection, functional behavior assessment, and development of a behavior intervention plan. This is the foundational assessment code for ABA services.
Time Requirements
Billed per 15-minute unit. Typical assessments range from 2-8 hours (8-32 units) depending on complexity.
Modifiers
| Code | Description |
|---|---|
| 97 | Habilitative services (some payers require to distinguish from rehabilitative). |
When to Use
- Initial ABA assessment for a new client
- Functional behavior assessment (FBA)
- Comprehensive reassessments required by treatment plan updates
- Behavioral assessments that lead to an intervention plan
When Not to Use
- Reassessments that are brief or protocol-based — use 97152
- Direct ABA therapy services — use 97153 or 97154
- Supervision of ABA technicians — use 97155 or 97156
Common Denial Reasons
- Exceeds payer-authorized assessment hours
- Documentation does not include all required FBA components
- Billed by a provider without BCBA or equivalent credentials
- Assessment repeated within a timeframe not supported by medical necessity
Payer Notes
Most payers authorize a set number of assessment hours (commonly 8-24 hours for initial assessments). Prior authorization is almost always required for ABA services. Some payers require the assessment to be completed within a defined window (e.g., 30 days).
Frequently Asked Questions
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