Billable Appointments and Rate Configuration

Fee schedules in PracticeABA define the rates you charge for each service code, broken down by insurance payer. Since different insurance companies reimburse at different rates for the same CPT code, maintaining accurate fee schedules is critical for proper claim submission and revenue forecasting. To create or edit fee schedules, navigate to Billing, then Fee Schedules in the sidebar.

Each fee schedule is associated with a specific payer or payer group. For example, you might have separate fee schedules for Blue Cross Blue Shield, Medicaid, Tricare, and your self-pay rates. Within each fee schedule, you define the rate per unit for every CPT code your practice bills. Common entries include 97153 (adaptive behavior treatment by protocol, delivered by an RBT), 97155 (adaptive behavior treatment with protocol modification, delivered by a BCBA), 97156 (family adaptive behavior treatment guidance), and 97151 (behavior identification assessment).

PracticeABA supports rate effective dates, which allow you to enter new rates that take effect on a future date without overwriting your current rates. This is particularly useful during annual contract renegotiations with payers. When a new rate period begins, the system automatically applies the updated rates to sessions occurring on or after the effective date while preserving the correct rates for historical sessions. You can also import fee schedules from a CSV file if you have rate tables from your contracts, saving significant data entry time when setting up a new payer.

PracticeABA uses appointment types to link scheduling with billing. Each appointment type is configured with a default CPT code, expected duration, and applicable modifiers. When a scheduler creates an appointment, they select the appointment type, and the billing information is automatically populated. This ensures that every session is associated with the correct billing parameters from the moment it is scheduled.

Common appointment types in an ABA practice include Direct Therapy (mapped to 97153), Supervision (mapped to 97155), Parent Training (mapped to 97156), Assessment (mapped to 97151), and Reassessment (mapped to 97152). Each type can have multiple duration options with corresponding unit counts. For example, a Direct Therapy appointment might be configured for 2-hour, 3-hour, or 4-hour blocks, with unit counts of 8, 12, and 16 respectively (based on 15-minute units).

Modifier codes are configured at the appointment type level and can be set to apply automatically based on certain conditions. The most common modifiers in ABA billing include modifier 97 (applied when services are rendered in a group setting), modifier HM (used for some Medicaid programs), modifier XE (separate encounter), and the standard evaluation and management modifiers. PracticeABA can also be configured to automatically apply the correct rendering provider modifier based on the credential level of the clinician delivering the service.

After a session is documented and signed, PracticeABA generates a billable charge in the Unbilled Charges queue. Before these charges are submitted as claims, billing staff should review them for accuracy. The Unbilled Charges page displays a list of charges with key details including the date of service, client name, rendering provider, CPT code, units, modifier codes, fee schedule rate, and total charge amount.

You can filter the Unbilled Charges list by date range, provider, client, or payer to focus your review on specific segments. Each charge row can be expanded to view the source session note, the authorization being utilized, and the calculated unit breakdown. If a charge needs adjustment, you can modify the CPT code, units, or modifiers directly from this screen. Common reasons for adjustment include sessions that ran shorter or longer than scheduled, service type changes that occurred during the session, or corrections to modifier codes.

PracticeABA flags charges that may need attention with visual indicators. A yellow warning appears when the billed units do not match the documented session time, when the rendering provider's credentials do not match the service code requirements, or when the authorization has insufficient remaining units. A red alert appears for more serious issues such as expired authorizations, missing provider credentials, or duplicate charges. Addressing these flags before claim submission significantly reduces your denial rate and accelerates your revenue cycle.