CPT code 97153: Adaptive behavior treatment, one patient, technician2026 Medicare rate & RVUs in Massachusetts
Reports face-to-face, one-to-one adaptive behavior treatment delivered by a technician following an established protocol, in 15-minute units.
CMS doesn’t publish an office rate for 97153 in Massachusetts.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 97153 covers
A behavior technician uses an established treatment protocol to work directly with one patient on adaptive behavior goals. This service is commonly part of applied behavior analysis, including treatment for autism-related behavioral needs. The technician delivers the protocol under the direction of a physician or other qualified health care professional; the code describes treatment, not an assessment or a group session.
Report the service in 15-minute units for face-to-face treatment. CMS assigns status C, or carrier priced, under the physician fee schedule: CMS publishes no national payment, and the Medicare Administrative Contractor sets payment for each claim. Select a different code when a technician is supporting an assessment, treatment is delivered to a group, or a physician or qualified health care professional provides treatment involving protocol modification.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 97153 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston, MA | Unavailable | Unavailable |
| Rest of Massachusetts | Unavailable | Unavailable |
How the 97153 rate is calculated
Each of 97153’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 97153
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.00
0.00 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
0.0000
Conversion factor
$33.4009
Medicare rate
$0.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 97153
97153 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 97153
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
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97153 isn’t priced in this setting.
97153 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 97154Group behavior treatmentTechnician, per 15 minutes
- Choose 97153 for technician treatment with one patient; choose 97154 when the technician delivers adaptive behavior treatment in a group.
- 97155Behavior treatmentProtocol modification
- 97153 is technician implementation of an established protocol. 97155 is treatment by a physician or qualified health care professional involving protocol modification.
- 97152Behavior assessmentTechnician support
- 97152 concerns technician support during behavior identification assessment; 97153 reports treatment under an established protocol.
97153 billing questions
How many minutes does one unit represent?
One unit represents 15 minutes of face-to-face adaptive behavior treatment delivered by a technician to one patient.
When should 97154 be used instead?
Use 97154 for technician-delivered adaptive behavior treatment in a group. Use 97153 for treatment delivered to one patient.
How does 97153 differ from 97155?
97153 describes a technician implementing an established protocol with one patient. 97155 describes treatment by a physician or qualified health care professional involving protocol modification.
Is 97153 an assessment code?
No. It reports treatment under a protocol. Technician support for a behavior identification assessment is described by 97152.
How does Medicare price 97153?
CMS assigns status C, or carrier priced, under the physician fee schedule. CMS publishes no national payment; the Medicare Administrative Contractor sets payment for each claim.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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