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Magellan adopts new CPT codes for applied behavior analysis Jan. 1

The American Medical Association (AMA) has issued new CPT® codes* for applied behavior analysis, beginning in 2019. Magellan will adopt these new codes, effective Jan. 1, 2019; however, some states may have varying implementation dates, which will be reflected in communications for those specific areas.

This change affects you if you are currently qualified to provide ABA services. You will receive a letter by mail notifying you of the change and how it affects your agreement with Magellan.

For dates of service on or after Jan. 1, 2019:

  • You should bill for ABA services using the new Category I CPT codes (permanent). This includes electronic and paper claims submissions.
  • Magellan will not accept the Category III CPT codes (temporary) for any dates of service after Dec. 31, 2018, as the AMA has retired these codes, except for temporary codes 0373T and 0362T, which they are retaining.

 For dates of service before Jan. 1, 2019:

 You may continue to bill your existing contracted codes for electronic or paper claims submissions. Timely filing limits apply.

 For authorizations that span into 2019: 

  • Magellan will honor all existing authorizations that extend into 2019. Magellan claims systems will adjudicate claims using the new Category I CPT codes for services authorized under your existing contracted codes. NOTE: Expiring Category III CPT codes (temporary) cannot be billed for dates of service after Dec. 31, 2018.
  • On Nov. 1, 2018, Magellan began issuing split authorizations using existing contracted codes for dates of service through Dec. 31, 2018, and the new Category I CPT codes for dates of service Jan. 1, 2019 and beyond.
  • For states that are adopting the coding change later than Jan 1, 2019, we will begin to issue split authorizations at a later date.

 For more information: 

  • The AMA administers the Category I CPT codes and owns the official descriptions; for more information about these CPT codes, please consult the AMA website at www.ama-assn.org.
  • Magellan has posted frequently asked questions (FAQ) and a webinar at www.MagellanProvider.com/Autism. Please be sure to check the FAQ periodically for updates as we will post new information there as it becomes available. 

*CPT Copyright 2017 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. 

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Welcome to Provider Focus, our award-winning e-newsletter for network providers! Here you’ll find articles and information to keep you up-to-date on news and topics relevant to serving Magellan members, including a section for regional- and plan-specific news. Check back as a new issue is released each quarter.

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