Medicaid B: Research Based Behavioral Health Treatment (RB-BHT)

• Clinical Coverage Policy 8F

Submission Requirements

RB-BHT Comprehensive Assessment (97151)
Initial: SAR and Assessment with Diagnosis of ASD using scientifically validated tool for diagnosis of ASD

RB-BHT Assessment Follow Up (97152)
Initial and Concurrent: SAR and current or Previous RB-BHT Assessment/Treatment Plan

RB-BHT (97153), RB-BHT group (97154), RB-BHT Adaptive Behavior Treatment with Protocol Modification (97155)
Initial: SAR, Behavioral/Adaptive/ Functional Assessment and RB-BHT Treatment Plan with baseline functional data (from standardized metrics) and implementation schedule
Concurrent: SAR, Behavioral/Adaptive/ Functional Assessment and updated RB-BHT Treatment Plan with current functional data compared to baseline (from standardized metrics) and implementation schedule

RB-BHT Parent Training without child (97156), RB-BHT Parent Training group (97157)
Initial: SAR, Assessment and RB-BHT Treatment Plan
Concurrent: SAR, Assessment and updated RB-BHT Treatment Plan

Service Definition Authorization Parameters

RB-BHT Comprehensive Assessment (97151)
Initial and Concurrent: Up to 32 units for 6 month period

RB-BHT Assessment Follow Up (97152)
Initial and Concurrent: Up to 6 hours for 6 months

RB-BHT (97153), RB-BHT group (97154), RB-BHT Adaptive Behavior Treatment with Protocol Modification (97155), 
Initial and Concurrent: up to 160 units (40 hours)/week  for 6 months

RB-BHT Parent Training without child (97156), RB-BHT Parent Training group (97157)
Initial and Concurrent: 12 units (3 hours) per week for 6 months