Are You Being Underpaid? Check Your Market Rates in 30 Seconds
The "Black Box" of ABA CPT Codes and Insurance Rates
If you ask three different ABA providers in the same zip code what they get paid for CPT 97153, you’ll likely get three different answers—and the variance can be shocking.
Navigating ABA billing codes is difficult enough without the added confusion of opaque reimbursement rates. For years, payers have relied on this lack of transparency. When you don't know what your neighbor is earning for the same ABA therapy CPT codes, you accept the first rate sheet you're given.
In an industry where margins are already squeezed by rising labor costs and administrative burden, blind acceptance is a luxury you cannot afford. Without data, you aren't negotiating; you’re guessing.
The Real Cost of a $5 Difference
It’s easy to dismiss a rate difference of $3 or $5 per unit as negligible. But in ABA, volume amplifies everything.
Let's look at the math for a single Registered Behavior Technician (RBT) billing 30 hours a week for CPT 97153 (Adaptive Behavior Treatment by Protocol):
- 30 hours/week = 120 units/week.
- $5 per unit difference = $600 in lost revenue per week.
- Annual Impact = $30,000+ in lost revenue per RBT, per year.
Now multiply that by the number of technicians in your clinic. The "small" gap in your rate sheet isn't just a couple of dollars—it’s the difference between hiring a new clinical director, expanding your benefits package, or simply staying profitable.
Introducing the CPT Benchmarking Widget
Knowing the code descriptions is standard, but knowing the market rate for those codes is your competitive advantage. We built the CPT Benchmarking Widget to stop the guessing game. It serves as a quick, commitment-free "pulse check" on your practice’s financial health.
Think of this as a credit score check for your revenue. It isn’t a full audit, but it’s the fastest way to answer the burning question: "Am I getting paid fair market value for my ABA CPT codes?"
What it does:
- Instant Snapshot: Enter your state and a CPT code (like 97151, 97153, or 97155) to see a high-level range of what peers in your area are receiving.
- Zero Friction: No spreadsheets, no long forms. Just instant market context.
Interpreting Your Results
Once you run the check, you’ll generally fall into one of three buckets. Here is what each one means for your business:
1. Below Market: The "Red Flag"
You are being underpaid relative to your peers. This is an immediate signal that you are leaving significant revenue on the table. You have the leverage of "fair market value" on your side—you just need the right data strategy to present it to payers.
2. At Market: The "Growth Opportunity"
You are consistent with the average, but in a high-cost environment, "average" doesn't always guarantee healthy margins. While you aren't being severely underpaid, there is likely room to optimize specific high-volume codes or negotiate better terms based on your clinical outcomes and access to care.
3. Above Market: "Scale & Retention"
You have secured strong rates—congratulations. Now the focus shifts to Talent & Margins. High reimbursement rates give you the competitive advantage to pay higher salaries and solve retention issues—but only if you manage your margins correctly. Are you reinvesting that revenue efficiently? You need robust financial infrastructure to ensure that competitive staff wages don't eat away at your profitability.
Don’t Leave Money on the Table—Let Us Help You Close the Gap
Whether you need to fight for fair reimbursement or balance competitive salaries with profitability, the widget is just the starting point. Flychain gives you the leverage and infrastructure to turn that data into a winning strategy.
If the benchmark tool shows you are trailing, a simple screenshot isn't enough to sway a payer. If you are leading the market, you need infrastructure to scale that success.
Flychain acts as the growth engine for ABA providers by:
- Strategic Rate Negotiation: We don't just analyze the data; we equip you with a comprehensive Contracted Rate Analysis to target and secure higher reimbursement tiers.
- Salary Benchmarking: We help you retain top talent by comparing your compensation packages against local market data, ensuring you can pay competitive wages without sacrificing your margins.
- Revenue Intelligence: We provide the financial visibility and benchmarking insights you need to optimize operations and confidently invest in your growth.
Try It Now
Stop wondering if the clinic down the street is getting paid more for the same services. The answer takes less than a minute to find.
Reference: ABA CPT Codes, Descriptions & National Averages
National averages calculated based on the 50th percentile (median) of state-level benchmark data.
| Code |
Code Description |
National Avg (p50) |
| 97151 |
Behavior Identification Assessment (per 15 min).
Face-to-face with patient/guardian. Used for initial assessment and re-assessment. |
$23.31 |
| 97152 |
Behavior Identification Supporting Assessment (per 15 min).
Face-to-face with patient. Administered by a technician under the direction of a QHP. |
$18.23 |
| 97153 |
Adaptive Behavior Treatment by Protocol (per 15 min).
Face-to-face, one-on-one therapy with the patient supervised by a physician or other qualified healthcare professional. |
$13.59 |
| 97154 |
Group Adaptive Behavior Treatment by Protocol (per 15 min).
Face-to-face with two or more patients. Administered by a technician. |
$11.58 |
| 97155 |
Adaptive Behavior Treatment with Protocol Modification (per 15 min).
Administered by QHP. Often billed concurrently with 97153 while the QHP directs the technician. |
$19.09 |
| 97156 |
Family Adaptive Behavior Treatment Guidance (per 15 min).
Parent training. Can be with or without the patient present. |
$18.40 |
| 97157 |
Multiple-Family Group Adaptive Behavior Treatment Guidance (per 15 min).
Parent training in a group setting. Patient is not present. |
$15.04 |
| 97158 |
Group Adaptive Behavior Treatment with Protocol Modification (per 15 min).
Group therapy (e.g., social skills) administered directly by the QHP for patients. |
$13.92 |
