ABA Terms Glossary

Short for accounts receivable, money owed to the practice for services already delivered.

A report that groups unpaid balances by how long they have been outstanding, such as 0 to 30, 31 to 60, 61 to 90 and over 90 days. It shows where collections are stalling.

Short for applied behavior analysis, the evidence-based clinical approach ABA practices deliver.

Money owed to the practice for services already delivered, from payors and from clients. A/R that grows older becomes harder to collect.

The payor's process of reviewing a claim against coverage, authorization and contract rules to decide whether to pay it in full, pay part of it or deny it.

AI that can plan and carry out multi-step tasks toward a goal within set rules, such as rebuilding a day's schedule after a callout while respecting authorizations, rather than only answering questions.

A formal request for a payor to overturn a claim denial, usually with supporting documentation such as session notes, authorizations or treatment plans.

A clinical approach that uses the principles of learning and behavior to teach meaningful skills and reduce behaviors that get in the way of daily life. ABA is the most widely used evidence-based service for autism and other developmental disabilities, delivered through individualized treatment plans and measured with ongoing data.

Short for autism spectrum disorder, the diagnosis behind most ABA coverage.

Approval for the initial or reassessment work, such as 97151 and 97152 units, that a BCBA needs to evaluate a client and write the treatment plan.

A gap after an authorization expires and before a new one is approved. Sessions in that gap are usually unpaid and care can be interrupted.

The share of authorized hours actually delivered and billed. Low utilization means care and revenue left on the table; over-utilization means unpaid sessions.

The start and end dates of an authorization. Services outside the window are not covered, even if units remain.

Scheduling that checks each session against the client's authorization, the provider's credentials and payor rules before it is booked, so every scheduled hour can be billed.

The number of units or hours a payor approved for each code within an authorization period. Scheduling beyond them may lead to unpaid work.

A neurodevelopmental condition that can affect communication, social interaction and behavior, diagnosed across a wide spectrum of needs. A documented autism diagnosis is usually the starting point for ABA coverage, assessment and treatment authorization.

Short for business associate agreement, the HIPAA contract a practice signs with vendors that handle client data.

Short for the Behavior Analyst Certification Board, which certifies BCBAs, BCaBAs and RBTs.

Measurements of a skill or behavior taken before treatment begins. Baseline data gives later progress something to be compared against and supports the case for continued authorization.

Short for Board Certified Assistant Behavior Analyst, a bachelor's-level practitioner supervised by a BCBA.

Short for Board Certified Behavior Analyst, the master's-level clinician who provides behavior-analytic services.

The nonprofit corporation that sets standards for and certifies behavior analysis practitioners, including BCBAs, BCaBAs and RBTs. Most state licensure laws for behavior analysts build on BACB standards.

The initial or follow-up evaluation a BCBA performs to understand a client's skills, needs and behaviors, including scoring, analysis and writing the treatment plan. It is billed with CPT 97151 and usually requires its own assessment authorization.

A written plan, built from FA and/or FBA results, that describes the function of the target behavior, how to teach replacement skills and how to respond consistently when the behavior occurs.

The staff member who delivers treatment by protocol face-to-face with a client, usually an RBT. In CPT language, technician services are billed under the direction of a physician or qualified health care professional.

The total amount a practice bills for services, before payor contracts reduce it to the contracted or allowed amount.

Short for behavior intervention plan, the written plan for preventing and responding to a target behavior.

A bachelor's-level, BACB-certified practitioner who delivers behavior-analytic services under the ongoing supervision of a BCBA. Payors differ on which services a BCaBA can bill and which modifier the claim needs.

A master's-level, BACB-certified clinician who conducts assessments, writes and adjusts treatment plans, supervises technicians and guides caregivers. BCBAs are the qualified health care professionals behind most ABA assessment and protocol-modification codes.

A HIPAA-required contract between a practice and a vendor that handles protected health information, such as a software or billing company, setting out how the vendor must protect that data.

The share of scheduled sessions canceled by families or staff. It is one of the biggest gaps between scheduled hours and delivered hours.

A national online database where providers store their credentialing information, such as licenses, education and practice locations, so payors can pull it. Keeping each clinician's profile current and re-attested speeds up credentialing.

Short for Claim Adjustment Reason Code, the standard code that explains why a claim was paid differently than billed.

Sessions in which a BCBA teaches parents or caregivers to use treatment strategies at home and in the community. Billed with 97156 for one family, or 97157 for a group of families.

The process by which a health insurance company (the carrier) negotiates, determines and applies reimbursement rates and allowed amounts for medical and behavioral services.

The set of clients assigned to a BCBA or technician.

Balancing client assignments across BCBAs and technicians by availability, credentials, location and supervision needs, so care stays consistent and staff are not overloaded.

The share of expected (allowed) revenue collected within a set window, such as 90 days after billing. It shows how much of expected revenue is collected and how quickly.

The timing of money coming in and going out. In ABA, revenue is earned when a session is delivered, but cash arrives only when the claim is paid, so revenue and cash can differ by weeks.

Short for the Council of Autism Service Providers, a trade association for autism service organizations.

Permanent CPT codes for established services. The ABA codes 97151 to 97158 are Category I codes, and six new Category I codes join them on January 1, 2027.

Temporary CPT codes for emerging services, ending in the letter T. ABA's two Category III codes, 0362T and 0373T, are being removed on January 1, 2027.

The federal agency that runs Medicare and oversees state Medicaid programs. Its annual fee schedule decisions influence how many payors price ABA codes.

A claim the payor processed and refused to pay, for reasons such as no authorization, ineligibility, coding errors or lack of medical necessity. Denials need correction, resubmission or an appeal.

The standard format for billing professional services such as ABA. The CMS-1500 is the paper form; the 837P is its electronic equivalent, which most payors require.

A claim sent back by the clearinghouse or payor before processing, usually for formatting or data errors. Rejected claims were never adjudicated and can be corrected and resubmitted.

Automated checks that catch errors in a claim before it reaches the payor, such as missing modifiers, invalid codes, eligibility gaps or units beyond the authorization.

A claim with no errors or missing information that a payor can process without asking for more information.

The share of claims that pass clearinghouse and payor edits on the first submission without being rejected or sent back. It measures how well claims are built before they go out.

A service or software that sits between practices and payors, checking claims for formatting and data errors and routing them electronically. It also returns payor responses and electronic remittances to the practice. Some clearinghouses also support eligibility and benefit checks.

Recording client responses and target behaviors during sessions, through data sheets or software, to measure progress and guide protocol changes. Clean session data also supports treatment plan updates and reauthorizations.

Short for the Centers for Medicare & Medicaid Services, the federal agency over Medicare and state Medicaid programs.

Short for coordination of benefits, the rules for which plan pays first when a client has more than one.

A map from old codes to new ones, used when a code set changes. ABA practices need one for the 2027 changes to update fee schedules, authorizations and billing rules before January 1.

Billing two services for the same time period, such as a technician's 97153 and a BCBA's 97155 during the same session. Payors set their own rules on which code pairs can overlap.

A payor's review of a client's progress during an active authorization to decide whether services should continue at the same level.

The difference between what a practice bills and what a payor's contract allows. It is expected and should be subtracted out when calculating net collection rate.

A fixed amount a family pays for a covered service, set by the client's plan.

A claim sent again with errors fixed after a rejection or denial. Payors have rules for how corrected claims are identified (such as including the original claim number and/or resubmission codes) and how long practices have to send them.

The part of a covered service the family pays, such as a copay, deductible or coinsurance.

A nonprofit trade association representing organizations that provide autism services, focused on quality standards, advocacy and industry guidance.

Short for Current Procedural Terminology, the AMA code set used to bill ABA services.

New for 2027. Assessment of harmful behavior delivered by two technicians in a setting customized for that behavior. Replaces 0362T. Billed in 15-minute units.

New for 2027. Add-on code for each additional technician beyond the two required for 97148. Billed in 15-minute units.

Behavior identification assessment by a physician or qualified health care professional (usually a BCBA), including face-to-face time with the client and caregivers plus non-face-to-face scoring, analysis and report writing. Billed in 15-minute units.

Behavior identification-supporting assessment administered by a technician under the direction of a BCBA, face-to-face with the client. Billed in 15-minute units.

Adaptive behavior treatment by protocol, delivered by a technician face-to-face with one client under a BCBA's direction. It is usually the highest-volume ABA code. Billed in 15-minute units.

Group adaptive behavior treatment by protocol, delivered by a technician face-to-face with two or more clients. Billed in 15-minute units.

Adaptive behavior treatment with protocol modification by a BCBA, face-to-face with one client. Starting January 1, 2027, 97155 is focused on the BCBA directing a technician during the session, and direct treatment with analysis moves to 97173. Billed in 15-minute units.

Family adaptive behavior treatment guidance by a BCBA, face-to-face with parents or caregivers, with or without the client present. Billed in 15-minute units.

Multiple-family group adaptive behavior treatment guidance by a BCBA, delivered to caregivers from more than one family without the clients present. Billed in 15-minute units.

Group adaptive behavior treatment with protocol modification by a BCBA, face-to-face with two or more clients. Billed in 15-minute units.

New for 2027. Treatment of harmful behavior delivered by two technicians in a customized setting. Replaces 0373T. Billed in 15-minute units.

New for 2027. Add-on code for each additional technician beyond the two required for 97159. Billed in 15-minute units.

New for 2027. Adaptive behavior treatment with analysis, delivered face-to-face by a BCBA to one client. Covers the direct-treatment work that moves out of 97155. Billed in 15-minute units.

New for 2027. Specified non-face-to-face adaptive behavior work by a BCBA, such as reviewing data and session notes, changing targets or protocols, planning assessments and building discharge plans. Billed in 15-minute units. Billed time is summed across one week and billed together on one claim line.

Modifiers that tell the payor the education level of the person who delivered the service: HM (less than a bachelor's, often RBTs), HN (bachelor's, often BCaBAs), HO (master's, often BCBAs) and HP (doctoral). Many Medicaid plans require them, and the rules vary by state.

The process of verifying a provider's education, licenses and certifications and enrolling them with each payor so they can bill for services. A provider who is not credentialed with a client's payor cannot be paid for that client.

The standard code set, maintained by the American Medical Association (AMA), that providers use to report medical and behavioral health services on claims. ABA services are billed mainly with the adaptive behavior CPT codes in the 97151 to 97158 range.

The date a session or service was delivered. The DOS decides which codes, rates, authorization and timely filing deadline apply, which is why the 2027 code changes take effect by date of service.

The average number of days it takes to collect payment after a service is billed, calculated as total A/R divided by average daily charges. Lower means cash arrives faster.

The amount a family must pay for covered services each plan year before insurance begins paying its share.

The process of preventing, tracking, working and learning from denied claims: triaging by reason code, prioritizing by value and deadline, correcting or appealing, and feeding root causes back upstream.

The share of submitted claims a payor denies. Tracked by payor and by reason, it shows where upstream processes like eligibility, authorization or credentialing break down.

Face-to-face ABA treatment delivered to one client, most often by a technician following the BCBA's protocol and billed with CPT 97153.

The plan for titrating a client off ABA services or moving them to another setting or level of care. Developing these plans is among the work recognized in the 2027 non-face-to-face code.

Short for date of service, the day a session was delivered.

Short for electronic funds transfer, a payor payment deposited directly to the practice's bank account.

Short for electronic health record, software that stores clinical records like treatment plans and session notes.

Payment deposited directly into the practice's bank account instead of a paper check. EFT payments are matched to ERAs so each deposit can be tied to the claims it pays.

Software that stores clinical records such as assessments, treatment plans, session notes and data. Some ABA practices run an EHR alongside separate practice management and billing tools.

The electronic file (the HIPAA X12 835 transaction) a payor sends to explain how each claim was paid, adjusted or denied, with reason codes for every line. Practices use ERAs to post payments automatically and spot denials fast.

Confirming a client's active coverage and benefits before services start and on a regular schedule, including copays, deductibles and visit limits. Missed eligibility checks are a leading cause of avoidable denials.

Short for electronic medical record, often used interchangeably with EHR.

Short for explanation of benefits, the payor statement showing what was billed, allowed, paid, denied and owed.

Short for electronic remittance advice, the 835 file that explains how each claim was paid.

A statement from the payor showing what was billed, what the plan allowed, what it paid and what the family owes for a service. Paper EOBs go to the member and sometimes the provider; ERAs are the electronic version for providers.

Short for functional behavior assessment, the process for finding out why a behavior occurs.

The share of claims paid in full on the first submission, with no rework, resubmission or appeal. Where clean claim rate checks whether a claim was accepted, first-pass yield checks whether it was paid.

A structured process for identifying why a behavior occurs, by looking at what comes before it, what follows it and what need it serves. FBA findings shape behavior goals and are often part of the documentation a payor reviews for authorization.

Payments divided by total billed charges, before contractual adjustments. Useful for trends, but net collection rate gives a truer view of performance.

ABA treatment delivered to two or more clients at the same time. Billed with 97154 when a technician delivers it by protocol, or 97158 when a BCBA delivers it with protocol modification.

A HCPCS Level II code for therapeutic behavioral services, per 15 minutes. Some state Medicaid programs and plans use it for ABA instead of the CPT adaptive behavior codes, so check the state manual.

Behavior that can injure the client or others and needs a specially designed setting and more than one technician to assess or treat safely. Starting in 2027, dedicated CPT codes (97148, 97149, 97159, 97160) cover these services.

Short for Healthcare Common Procedure Coding System, the national code set that includes CPT plus Level II codes like H2019.

A national code set that includes CPT (Level I) and additional codes for services and supplies CPT does not cover (Level II). Some state Medicaid programs require HCPCS codes such as H2019 for ABA instead of, or alongside, CPT codes.

The federal law that protects the privacy and security of health information. Its rules govern how ABA practices and their vendors store, share and access client records.

The standard code set for diagnoses on U.S. claims. ABA claims usually carry an autism diagnosis code such as F84.0, and the diagnosis must match what the payor authorized.

The process from a family's first inquiry to the first session: collecting information, verifying insurance, gathering diagnosis records and scheduling the assessment. Accurate intake is where clean claims start.

Short for individualized treatment plan, the document that sets goals and recommended hours.

A metric a practice tracks to judge performance, such as denial rate, clean claim rate, days in A/R, net collection rate and authorization utilization.

Short for key performance indicator, a metric a practice tracks to judge performance.

A health plan that contracts with a state Medicaid program to manage members' care and pay providers. Many Medicaid ABA claims go to MCOs, each with its own authorization and billing rules.

Short for managed care organization, a plan that manages care and pays providers for Medicaid or employer members.

Treatment goals written so progress can be counted or observed, such as how often or how independently a skill is performed. Payors expect measurable goals in treatment plans and progress reports.

The joint federal and state health coverage program for eligible individuals and children. Medicaid covers medically necessary ABA for eligible children, but codes, rates and rules differ by state. Eligibility is often income-based, but there may be other qualifying criteria as well.

A payor's determination that a service is clinically appropriate and needed for the client's condition. Treatment plans, assessments and progress data are how practices show medical necessity.

The identification number a payor assigns to a covered person. A mistyped or outdated member ID is one of the simplest causes of a rejected claim.

A two-character code added to a procedure code to give the payor more detail, such as who delivered the service or how it was delivered. A missing or wrong modifier is a common cause of denials or incorrect payments.

A unique 10-digit number issued by CMS to every health care provider who bills electronically. Individual clinicians get a Type 1 NPI and organizations get a Type 2 NPI; both usually appear on ABA claims.

The share of collectible revenue the practice actually collects: payments divided by charges after contractual adjustments. It shows how much of what you are owed you really receive.

Clinical work done without the client present, such as reviewing data, analyzing progress, scoring assessments and writing reports. Some is bundled into other codes today; starting in 2027, CPT 97180 covers specified non-face-to-face work.

Short for National Provider Identifier, the 10-digit number every billing provider gets from CMS.

Delivering more units than an authorization allows. Those extra sessions typically go unpaid.

Short for prior authorization, payor approval required before ABA services are delivered.

The share of a practice's clients or revenue that comes from each payor or payor type. It shapes cash flow, reimbursement rates and how much administrative work billing takes.

The organization that pays for covered services, such as a commercial insurer, Medicaid plan or employer health plan. Each payor sets its own rules for authorizations, codes, modifiers and documentation.

The agreement between a practice and a payor that sets covered services, reimbursement rates and billing rules. Rate negotiations happen when contracts are signed or renewed.

A two-digit code on the claim that says where the service happened, such as 11 (office), 12 (home), 03 (school), 02 (telehealth outside the client's home) or 10 (telehealth in the client's home). The wrong POS can change payment or trigger a denial.

Short for place of service, the two-digit code that tells the payor where a session happened.

Using a practice's own operational and financial data, together with automation, to spot problems early and guide decisions, such as an expiring authorization, an uncredentialed provider or a schedule that will not hit authorized hours.

Software that runs the business side of an ABA practice: intake, scheduling, authorizations, credentialing, billing and reporting. Connected systems reduce double entry and catch errors before they become denials.

One system that runs a practice's clinical and business work together, from intake and scheduling to authorizations, credentialing and billing, instead of a patchwork of separate tools. It is the foundation that practice intelligence is built on.

Payor approval required before services start, specifying which codes, how many units and which date range are covered. If the payor requires authorization and services are rendered without obtaining it, claims are likely to be denied.

A BCBA adjusting a client's treatment protocol, such as targets, prompts or reinforcement, based on session data. Protocol modification is the analysis work behind codes such as 97155.

Short for qualified health care professional, the CPT term for the provider (usually a BCBA) who bills assessment and protocol-modification codes.

The CPT term for a provider who is qualified by education, training and licensure or certification to perform a service independently. In ABA this is usually a BCBA, who bills the assessment, protocol-modification and caregiver-guidance codes.

Short for Remittance Advice Remark Code, a remark sent with a CARC that gives further detail on the adjustment reason.

Short for Registered Behavior Technician, the certified technician who delivers most direct ABA hours.

Short for revenue cycle management: everything that turns a scheduled session into collected revenue.

Standard codes payors return to explain a payment adjustment or denial. Claim Adjustment Reason Codes (CARCs) explain why a claim was paid differently than billed; Remittance Advice Remark Codes (RARCs) add detail.

Requesting a new authorization before the current one expires, usually with updated progress data and a revised treatment plan. Late reauthorizations create gaps in care and unpaid sessions.

A request asking a payor to review a denied claim again, often the first step before a formal appeal. Many payors require it within a set window after the denial or date of service.

A paraprofessional certified by the BACB who delivers direct ABA treatment by protocol under close supervision. RBTs provide most 1:1 therapy hours, so their schedules, credentials and session notes drive a large share of practice revenue.

Everything that turns a scheduled session into collected revenue: intake, eligibility, authorizations, credentialing, documentation, coding, claim submission, payment posting, denial follow-up and collections.

Projecting revenue and cash from four numbers: hours authorized, hours scheduled, hours delivered and hours billed. Comparing them each week shows where revenue is leaking.

Revenue lost between authorization and payment, through gaps such as unscheduled authorized hours, canceled sessions, undocumented sessions and unpaid claims.

A second plan that pays after the primary plan has processed a claim. Coordinating benefits correctly keeps claims from being denied or paid twice.

Services a family pays for directly, without insurance. May sometimes be used to refer to the out-of-pocket cost after insurance has paid its portion.

The clinical record of a single session: who delivered it, documented start and stop times, services and goals addressed, and data collected. A complete session note is what turns delivered hours into billable hours.

The BCBA's ongoing oversight of technicians and assistant analysts: observing sessions, modifying protocols and checking treatment fidelity. Payors and the BACB both set supervision expectations, and missing them can put claims and credentials at risk.

The required amount of BCBA supervision relative to the direct treatment hours a technician delivers, set by payors, state rules and BACB standards. Tracking it per client and per technician keeps care compliant and claims defensible.

A specific, observable behavior a treatment plan aims to increase or decrease. Clear target behaviors make data collection consistent across technicians and sessions.

Delivering ABA services, most often caregiver guidance or supervision, through real-time audio and video. Coverage, allowed codes, place-of-service codes and modifiers vary by payor and state.

Modifiers that flag a service delivered by real-time audio and video. Modifier 95 is the current standard for synchronous telehealth; GT is an older modifier that some payors still require.

The deadline a payor sets for submitting a claim, or a corrected claim or appeal, after the date of service or prior adjudication date. Limits vary by payor, and claims filed late are usually not appealable.

Approval for ongoing treatment hours, usually based on the submitted treatment plan, covering specific codes and units for a set period such as six months.

The written plan that sets a client's measurable goals, target behaviors, teaching strategies and recommended treatment hours. Payors use it to judge medical necessity, so it drives both the authorization and the schedule.

A claim paid below the contracted rate or the amount owed. Catching underpayments takes comparing each payment against the payor contract.

The time increment a service is billed in. ABA codes are billed in 15-minute units, and payors set rules for rounding partial units and counting units against the authorization.

Short for verification of benefits, confirming a client's coverage and ABA benefits before services start.

An amount removed from accounts receivable because it will not be collected. Contractual write-offs are expected under payor contracts; write-offs from preventable denials are lost revenue.

A Category III code for behavior identification-supporting assessment of severe behavior requiring two or more technicians in a customized setting. Deleted for dates of service on or after January 1, 2027; use 97148 and 97149.

A Category III code for adaptive behavior treatment of severe behavior requiring two or more technicians in a customized setting. Deleted for dates of service on or after January 1, 2027; use 97159 and 97160.