What Happens at an ABA Assessment (CPT 97151)

CPT 97151 is the billing code for a behavior identification assessment in ABA, billed in 15-minute units of the BCBA’s time. The assessment is the step between your child’s autism diagnosis and the first therapy session. A BCBA interviews you, watches your child, tests specific skills, and writes the treatment plan that your insurer will review. The diagnosis says your child is autistic. The assessment says what to teach first, how many hours it should take, and how everyone will know it is working.

Most of what you will live with for the next six months comes out of this plan, so it is worth knowing what a good one looks like before you sit down for it.

What CPT 97151 covers

97151 is the code for a behavior identification assessment. It is billed in 15-minute units of the BCBA’s time, and it covers two kinds of work:

• Face-to-face time with your child and with you: interviews, observation, and testing.
• Time without you there: reviewing records and past data, scoring the tests, writing the report, and building the treatment plan.

That second part surprises some parents when they see the explanation of benefits. If the EOB shows more 97151 units than the hours you spent in the room, report writing and scoring are usually the reason. It is fair to ask the provider for a breakdown.

A related code, 97152, is a supporting assessment given face-to-face with your child, usually by a technician following the BCBA’s direction, as the Mississippi Insurance Department’s 2019 ABA CPT overview describes. 97151 is the code that covers the BCBA’s indirect work, like scoring and report writing.

Another, 0362T, is for a supporting assessment of severe behavior, such as serious self-injury or aggression. It uses a BCBA plus two or more technicians in a specially set-up room. Most children never need it.

What changes on January 1, 2027. The 2027 CPT code book retires 0362T. A supporting assessment of harmful behavior with two technicians becomes 97148, and 97149 is added for each additional technician. 97151 and 97152 stay, with small wording changes. If your child’s assessment authorization runs past January 1 and lists 0362T, ask your provider whether the insurer will reissue it under the new code so nothing is delayed. Our post on the 2027 ABA code changes covers the full list.

What happens during the assessment

The order varies by clinic, but the parts are fairly standard.

Records review. The BCBA reads the diagnostic report, any IEP or school evaluation, speech and occupational therapy notes, and reports from earlier ABA. Send these ahead of time. A BCBA who has read the speech therapist’s goals can avoid writing conflicting ones.

Caregiver interview. Expect questions about daily routines, sleep, eating, toileting, communication, play, safety, and what a hard day looks like. You may fill out rating scales. This part does not need your child in the room.

Direct observation. The BCBA watches your child play, transition, follow directions, ask for things, and handle the word “no.” This might happen in the clinic, at home, or both.

Skills testing. Many BCBAs use a structured tool to measure language, social, play, and daily-living skills. Common ones include the VB-MAPP, ABLLS-R, AFLS, PEAK, and the Vineland adaptive behavior scales. The specific tool matters less than whether it fits your child’s age and language level. A curriculum built for toddlers is the wrong test for a talkative 10-year-old.

Functional behavior assessment, if needed. If your child has behavior that causes harm or gets in the way of learning, the BCBA tries to find out what the behavior does for your child: escape a demand, get attention, get an item, or something sensory. That usually means asking you detailed questions and recording what happens right before and after the behavior. The answer drives the plan. Teaching a child to ask for a break works when the behavior is about escape. It does nothing when the behavior is about attention.

What you should get at the end

The written report and treatment plan should include:

• your child’s background, including other services and how ABA will fit around them
• which assessments were used and what they found
• functional behavior assessment results, if one was done
• specific, measurable goals, grouped by area (communication, social, daily living, behavior)
• the recommended weekly hours, setting, and the reasoning behind both
• goals for you, the caregiver, not just for your child
• how the team will coordinate with school and other therapists
• a plan for maintenance, generalization, and eventual discharge

That last item is often skipped. Washington Apple Health requires it in every ABA plan, even at intake, when the HCA billing guide says it can be broad. Our post on how long ABA therapy lasts covers what that section should say.

Ask to go over the plan with the BCBA before it is sent to insurance. You are signing it. You should understand every goal and agree that it matters for your family.

How long the assessment takes

Usually several hours of BCBA time, often spread across two or more visits, plus time to write it up. Young children may need shorter visits on different days, because a tired three-year-old does not show what they can do.

Apple Health gives a useful reference point. For home and community ABA, it limits 97151 to 28 units per assessment, which is seven hours, and two assessments per calendar year. It does not require prior authorization for the assessment itself. The provider then has 60 days from the assessment date to get the authorization request for treatment to HCA.

Other public payers set different numbers. TRICARE’s East Region CPT tip sheet approves 32 units for an initial assessment and 24 for a reassessment, every six months.

Commercial plans vary. Some cover the assessment with no prior approval. Others want authorization before the BCBA can bill a single unit. Your provider’s intake team should check this before scheduling, and it is fine to ask them what they found.

Can the assessment happen by video?

Partly. Apple Health allows the indirect parts of 97151 by telemedicine: caregiver interviews, rating scales, records review, scoring, and writing the plan. It does not allow direct observation or direct skills testing by video. Those happen in person. Commercial plans set their own rules. Our post on which ABA codes Washington pays by video goes through the full list.

How to prepare

• Gather documents. Diagnostic report, insurance card, IEP or 504 plan, and recent speech, OT, or medical notes.
• Write down your top three priorities. What would make the biggest difference at home in six months? Sleeping through the night, asking for help instead of hitting, using the toilet at school? Those belong in the plan.
• Take a short video of a hard moment. A 30-second clip of a meltdown at the grocery store or a bedtime standoff can show the BCBA something your child may never do in the clinic.
• Bring snacks and a favorite item. Skills testing goes better when your child is comfortable.
• Plan who attends. If two caregivers handle mornings and bedtime, both should be part of the interview.

Red flags in the treatment plan

• Goals that read like they were copied from another child’s plan.
• A recommended number of hours with no explanation.
• No caregiver goals at all.
• Behavior goals that only say “decrease” without teaching a replacement.
• Nothing about your priorities, even though you stated them.
• No mention of your child’s assent: how the team will notice and respond when your child is saying no.
• No discharge or fading criteria.

You can ask for changes before the plan is submitted. If the provider will not discuss it, that tells you something about the next six months. Our list of questions to ask a new ABA provider is a good companion for that conversation.

After the first assessment

The assessment repeats. Apple Health grants ABA authorizations in three- to six-month blocks, and every renewal needs a reassessment and an updated plan that shows measurable progress. Commercial plans often work on a similar six-month cycle. Each reassessment is billed as 97151 again.

That is your regular chance to ask whether the goals still fit. Our guide to reading an ABA progress report explains what to look for in the numbers. If the reassessment asks for more hours, our ABA hours guide covers how that number should be justified.

Starting with an assessment at Orchid

At Orchid, the first visit is the assessment. We meet with you and your child, go through the history, and watch your child play, with plenty of their favorite things on hand. When challenging behavior is part of the picture, our team uses Practical Functional Assessment, which is built to find the reason behind a behavior while keeping your child safe and calm. It reacts to the early signs of distress instead of waiting for the behavior to escalate. Before anything goes to insurance, we go through the goals with you.

We check your benefits before scheduling, including whether your plan needs approval for the assessment itself.

Request a call back to start the benefits check, or see ABA therapy at Orchid and our locations.