Clinical Policy Title: Autism spectrum disorder treatments

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1 Clinical Policy Title: Autism spectrum disorder treatments Clinical Policy Number: Effective Date: May 1, 2017 Initial Review Date: April 19, 2017 Most Recent Review Date: March 6, 2018 Next Review Date: March 2019 Policy contains: Autism. Autism spectrum disorders. Related policies: CP# CP# Applied behavioral analysis. Genetic testing for autism spectrum disorders. ABOUT THIS POLICY: Select Health of South Carolina has developed clinical policies to assist with making coverage determinations. Select Health of South Carolina s clinical policies are based on guidelines from established industry sources, such as the Centers for Medicare & Medicaid Services (CMS), state regulatory agencies, the American Medical Association (AMA), medical specialty professional societies, and peerreviewed professional literature. These clinical policies along with other sources, such as plan benefits and state and federal laws and regulatory requirements, including any state- or plan-specific definition of medically necessary, and the specific facts of the particular situation are considered by Select Health of South Carolina when making coverage determinations. In the event of conflict between this clinical policy and plan benefits and/or state or federal laws and/or regulatory requirements, the plan benefits and/or state and federal laws and/or regulatory requirements shall control. Select Health of South Carolina s clinical policies are for informational purposes only and not intended as medical advice or to direct treatment. Physicians and other health care providers are solely responsible for the treatment decisions for their patients. Select Health of South Carolina s clinical policies are reflective of evidence-based medicine at the time of review. As medical science evolves, Select Health of South Carolina will update its clinical policies as necessary. Select Health of South Carolina s clinical policies are not guarantees of payment. Coverage policy Select Health of South Carolina considers the treatment of autism spectrum disorders to be clinically proven, and therefore, medically necessary, for the following therapies: Certain medications for treating symptoms including, but not limited to, aggression, hyperactivity, inattention, depression, anxiety, high energy levels, inability to focus, depression, or seizures. Behavioral and communication approaches, including but not limited to, applied behavioral analysis, physical therapy, occupational therapy, psychotherapy, sensory integration therapy, speech therapy, and picture exchange communication system. Any of the above treatments must be the result of a multi-disciplinary consensus by a team that has thoroughly evaluated the patient. Potential benefits and risks of treatments must be discussed with parents or guardians of a child with autism spectrum disorder by a qualified care giver (CDC, 2015). Limitations: 1

2 Select Health of South Carolina considers the use of the following treatment approaches to autism spectrum disorder to be investigational/experimental, and therefore not medically necessary. Any dietary approaches that differ from standard recommendations for children. Any complementary and alternative treatments. Alternative covered services: None. Background Autism spectrum disorder is a group of neurodevelopmental conditions. The defining traits of autism spectrum disorder are limited verbal and non-verbal variable social communication/interaction, limited activities and interests, and repetitive patterns of behavior. Autism spectrum disorder cannot be diagnosed at birth, but nearly all cases are diagnosed by the age of three, suggesting a genetic defect as a potential cause, even though autism spectrum disorder etiology is still not well understood. Symptoms that may reveal the presence of autism spectrum disorder include late onset or limited levels of babbling, gesturing, speaking single words, initiating spoken phrases, along with loss of language or social skills. While no cause has been identified, risk factors such as children born to older parents or born prematurely have been documented. The U.S. Centers for Disease Control and Prevention (CDC) estimated in 2012 that 1 in 68 U.S. children had autism spectrum disorder, more than twice as high from the 2002 estimate of 1 in 150 children. The disease is five times more common in boys than girls (1 in 42 vs. 1 in 189), and whites are more likely than black or Hispanics to develop the disease (CDC, 2016). These latest figures continue a prolonged trend; the percent of U.S. children ages 3 to 17 with parent-reported diagnosis of autism spectrum disorder soared from 0.10 to 2.24 percent from 1997 to 2014, more than a 20-fold increase (Zablotsky, 2015). Certain geographic areas have higher rates; 1 of 45 8-year olds in four New Jersey counties had the disease in 2010, about 50 percent greater than the national average. The figure for New Jersey boys was 1 in 28 (CDC, 2010). The most recent estimate of U.S. prevalence of autism spectrum disorder among children age 3 17 was issued in November In this publication, data showed the U.S. rate rose each year from 2014 to 2016; in the latest year, the prevalence was 2.76 percent, or 1 in 36 children (CDC, 2017). The diagnosis of autism spectrum disorder typically begins after particular neurodevelopmental symptoms are noticeable. A comprehensive review of the mother s history during pregnancy and delivery, along with the child s medical history, and family medical history, is conducted. Screening is also recommended by the American Academy of Pediatrics during well visits at age 18, 24, and 30 months, as these are the ages when symptoms are often present. Among the diagnostic tests for autism spectrum disorder are electroencephalogram, audiologic/speech/language evaluation, and genetic counseling and testing. 2

3 A speech language pathologist plays a role in diagnosing autism spectrum disorder, as speech deficiencies are a major symptom of the disorder. Occupational and physical therapists typically conduct testing, along with child psychologists, neurologists, audiologists, and sometimes medical geneticists. Teachers may conduct an evaluation of academic achievement if the child is in school. Because diagnostic criteria is largely based on observations, and because other diagnoses must be ruled out, accurate diagnosis of autism spectrum disorder incorporates the findings of professionals from multiple disciplines. There is no uniform method of treating autism spectrum disorder, nor is there a cure. Attempting to achieve the goals of minimizing symptoms, maximizing independence and quality of life, and alleviating family concerns constitute the generic goals of any treatment program (CDC, 2015; NICE, 2016). Guidelines for the structure of autism spectrum disorder treatment recommend coordinated care by a local autism multi-agency strategy group, and that management and coordination of care for the young be handled by local specialist community-based multi-disciplinary teams. Care for the transition of the patient into adulthood is also addressed (AHRQ, 2013). Asperger s syndrome is a milder type of autism spectrum disorder, marked by a much greater language ability and intelligence. In this policy, Asperger s is not addressed separately from autism spectrum disorder. Searches Select Health of South Carolina searched PubMed and the databases of: UK National Health Services Centre for Reviews and Dissemination. Agency for Healthcare Research and Quality s National Guideline Clearinghouse and other evidence-based practice centers. The Centers for Medicare & Medicaid Services (CMS). We conducted searches on February 5, Search terms were: autism and treatment or applied behavior analysis. We included: Systematic reviews, which pool results from multiple studies to achieve larger sample sizes and greater precision of effect estimation than in smaller primary studies. Systematic reviews use predetermined transparent methods to minimize bias, effectively treating the review as a scientific endeavor, and are thus rated highest in evidence-grading hierarchies. Guidelines based on systematic reviews. 3

4 Economic analyses, such as cost-effectiveness, and benefit or utility studies (but not simple cost studies), reporting both costs and outcomes sometimes referred to as efficiency studies which also rank near the top of evidence hierarchies. Findings In 2016, the National Institute for Health and Care Excellence developed a pathway for autism treatment and support. Interventions are to be directed at core features of autism, coexisting mental health and medical problems, behavior challenges, and services that should not be used. Accompanying these targets are life skills and sleep problems (NICE, 2016). The CDC guideline identifies four categories of treatment, namely: Medication. This is considered necessary for certain cases, such as managing high energy levels, inability to focus, depression, or seizures. Behavioral and communication approaches. This includes applied behavioral analysis, occupational therapy, sensory integration therapy, speech therapy, and picture exchange communication system. All are helpful to autism spectrum disorder, according to the American Academy of Pediatrics and the National Research Council. Dietary approaches. These have been developed by reliable therapists, but most lack the scientific support for recommendation. Complementary and alternative treatments. These have been used by as many as one-third of parents of a child with autism spectrum disorder, but are very controversial; some may be dangerous (CDC, 2015). The American Academy of Child and Adolescent Psychiatry made four recommendations on autism spectrum disorder treatment in its 2014 practice parameter, which closely resemble those of the CDC: The clinician should help the family obtain appropriate, evidence-based and structured educational and behavioral interventions for children with autism spectrum disorder. Pharmacotherapy may be offered to children with autism spectrum disorder where there is a specific target symptom or comorbid condition. The clinician should maintain an active role in long-term treatment planning and family support, as well as support of the individual. Clinicians should specifically inquire about the use of alternative/complementary treatments, and be prepared to discuss their risk and potential benefits. The Agency for Healthcare Quality and Research evaluated treatments for adolescents and young adults with autism spectrum disorder. A thorough literature review found that evidence for all treatments were judged insufficient and thus, no recommendations could be made (AHRQ, 2014). Assessments of the efficacy of applied behavioral analysis include a review of 52 studies calling the treatment mostly controversial, expensive, and dependent of external variables (Fernandes, 2013). 4

5 Another linked long-term applied behavioral analysis with improvements among the ASD population primarily in language-related outcomes, plus non-verbal IQ, social functioning, and daily living skills (Virues-Ortega, 2010). An article of 22 reviews found multiple interventions (including applied behavioral analysis) improved cognition and functioning among preschoolers (Weinmann, 2009). Parent inclusion in applied behavioral analysis also improves outcomes (Strauss, 2013). Cognitive behavioral therapy showed a medium-to-significant improvement in ASD symptoms in a 48-study review (Weston, 2016). Efficacy of prescription drugs on autism spectrum disorder includes a review of 47 studies (n=300,000), finding some evidence for use of antipsychotics, but not antidepressants (Jobski, 2017). Another found limited and conflicting evidence for tricyclic antidepressants (Hurwitz, 2012). Reviews of opioid antagonists found reduced irritability and hyperactivity (Roy, 2015a) and self-injurious behavior (Roy, 2015b). Citaopram and buspirone, but not fluvoxamine, were linked with modest reductions in anxiety (Vasa, 2014). The effects of the antipsychotic drug Aripiprazole on autism spectrum disorder is the topic of two systematic reviews. One found it effective short-term (Hirsch, 2016), while another showed reductions in hyperactivity and purposeless repetition, with a number of side effects (Ching, 2012). Oxytocin treatment was found to be well tolerated and improved emotion recognition for six weeks in a review of seven studies (Preti, 2014). Other systematic reviews cover a variety of autism spectrum disorder treatments: Acupuncture versus conventional language therapy or placebo improved ASD (Lee, 2012), but not to improve core autistic features, communication and linguistic ability in another (Cheuk, 2011). Massage therapy for autism spectrum disorder patients, in conjunction with conventional language therapy, improved communication attitude and symptom severity versus conventional language therapy alone; significantly improved sensory profile, adaptive behavior, and language/social ability vs. special education; and significantly improved social communication when used as solo therapy (Lee, 2011). Hyperbaric oxygen therapy 10 times versus five times weekly improved hypoperfusion, inflammation, mitochondirial dysfunction, and oxidative stress in autism spectrum disorder patients (Rossignol, 2012). A review of 16 studies (n=900) found 1 2 doses of IV secretin (a hormone) for autism spectrum disorder was not effective at improving core autism spectrum disorder functions (Williams, 2012). Four studies of week treatments of hydrotherapy for high-functioning autism spectrum disorder patients age 3 12 found some improvement in social interactions or behavior (Mortimer, 2012). 5

6 In five studies (n=223) of autism spectrum disorder patients, the drug oxytocin, compared to placebo, was found to be well tolerated and safe, as no difference in adverse effects were statistically significant (Cai, 2017). A Cochrane review of four studies (n=113) of autism spectrum disorder showed that high dose methylphenidate significantly benefitted hyperactivity rated by teachers and parents, along with a significant benefit to teacher=rated inattention (Sturman, 2017). A meta-analysis of long chain n-3 polyunsaturated fatty acid supplementation included 15 studies (n=1193); compared with placebo, supplementation improved social interaction and repetitive and restricted interests and behaviors (Mazahery, 2017). Conversely, another systematic review found no evidence that these fatty acids enhanced performance of children with autism spectrum disorders (Horvath, 2017). A meta-analysis of 38 studies showed no one sleep problem intervention in autism spectrum disorder is effective for all problems; however, melatonin, behavioral interventions, and parent education/education programs appear most effective (Cuomo, 2017). A systematic review of 10 randomized trials (n=567) concluded efficacy of herbal medicines for autism treatment appears encouraging, but inconclusive due to methodological quality issues (Bang, 2017). A systematic review of 24 studies, including 20 randomized trials, concluded sensory integration-based therapy improved sensory and motor skills-related measures, while environmental enrichment improved nonverbal cognitive skills, but studies were generally small and short-term (Weitlauf, 2017). Direct lifetime costs of medical and nonmedical care for Americans born in 2000 and diagnosed with autism spectrum disorder in 2003 who live to age 65 was $3.2 million per person in 2003, noting high costs continue into adulthood. About 60 percent of these costs are indirect (loss of expected income/productivity (Ganz 2007). Annual Medicaid expenses for adults with the disease were 60 percent greater than other Medicaid recipients ($13,700 versus $8,560). Adults with autism spectrum disorder had higher average annual outpatient office visits (32 versus eight) and higher prescription drug use claims (51 versus 24) (Vohra, 2016). Policy updates: A total of one guideline/other and seven peer-reviewed references were added to this policy in February Summary of clinical evidence: Citation Jobski (2017) Content, Methods, Recommendations Key points: Prevalence and patterns of psychopharmacotherapy in ASD patients Systematic review of 47 studies, over 300,000 ASD patients. Median prevalence of psychopharmacotherapy is 45.7%, and 23.0% for psychotropic polypharmacy. Antipsychotics most frequently used, followed by ADHD medications and 6

7 Citation CDC (2015) Content, Methods, Recommendations antidepressants. Older age and psychiatric comorbidity associated with greater use of these drugs. Key points: ASD treatment recommendations There are no medications that can cure ASD or treat core symptoms, but some can help people improve function; early intervention is especially helpful. Behavior and communication approaches can help provide structure, direction, and organization to the child and family. Various medications have been shown to help related symptoms with ASD. Dietary approaches have been developed, but lack the scientific support needed for widespread recommendation. Complementary and alternative treatments are often used, but lack scientific support, and in some cases may even pose dangers to the ASD patient. Roy (2015a) Key points: Effectiveness of opioid antagonists in attenuating core ASD symptoms Systematic review of 10 studies (n=128). 77% of those on naltrexone had significant improvement in irritability and hyperactivity. No evidence that naltrexone has positive impact on core ASD features. Lee (2012) Key points: Effectiveness of acupuncture to treat ASD Systematic review of 11 randomized controlled trials (RCTs). Two RCTs found that acupuncture plus conventional language therapy was superior to sham acupuncture plus conventional therapy. Two RCTs found that acupuncture produced significantly superior results vs. conventional language therapy or complex interventions. Three RCTs found that acupuncture plus conventional therapies were superior to conventional therapy alone. Four RCTs found that acupuncture was significantly superior to patients on waiting lists or who received no treatment. References Professional society guidelines/other: Agency for Healthcare Research and Quality (AHRQ). Autism: The management and support of young people on the autism spectrum. Rockville MD: AHRQ Accessed February 5, Agency for Healthcare Research and Quality (AHRQ). Comparative effectiveness review number 65. Interventions for adolescents and young adults with autism spectrum disorders. Rockville MD: AHRQ 7

8 Accessed February 5, National Collaborating Centre for Mental Health. Autism: The management and support of children and young people on the autism spectrum. London: National Institute for Health and Care Excellence (NICE) Accessed February 5, National Institute for Health and Care Excellence (NICE). Management and support in children and young people with autism. Critical pathway. London: NICE Accessed February 5, National Institute for Health and Clinical Excellence (NICE): Autism: recognition, referral, diagnosis and management of adults on the autism spectrum. London: NICE Accessed February 5, Tomchek SD, Koenig KP. Occupational therapy practice guidelines for individuals with autism spectrum disorder. Bethesda MD: American Occupational Therapy Association, Inc. (AOTA) Accessed February 5, U.S. Centers for Disease Control and Prevention (CDC). New Jersey: Tracking Autism Spectrum Disorder and Other Developmental Disabilities in New Jersey: What You Need to Know. Atlanta GA: CDC, Accessed February 5, U.S. Centers for Disease Control and Prevention (CDC). Estimated Prevalence of Children With Diagnosed Developmental Disabilities in the United States, Atlanta GA: CDC, National Centers for Health Statistics data brief No. 291, November Accessed February 5, U.S. Centers for Disease Control and Prevention (CDC). Autism Spectrum Disorder: Data and Statistics. September Accessed February 5, U.S. Centers for Disease Control and Prevention (CDC). Autism Spectrum Disorder: Treatment. August Accessed February 5, Volkmar F, Siegel M, Woodbury-Smith M, et al. and the American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. J Am Acad Child Adolesc Psychiatry. 2014;53(2):

9 Accessed February 5, Zablotsky B, Black LI, Maenner MJ, Schieve LA, Blumberrg SJ. Estimated prevalence of autism and other developmental disabilities following questionnaire changes in the 2014 National Health Interview Survey. National Health Statistics Reports. Hyattsville MD: National Center for Health Statistics, November 13, Accessed February 5, Peer-reviewed references: Bang M, Lee SH, Cho SH, et al. Herbal medicine treatment for children with autism spectrum disorder: A systematic review. Evid Based Complement Alternat Med. 2017;2017: Doi: /2017/ Cai Q, Feng L, Yap KZ. Systematic review and meta-analysis of reported adverse events of long-term intranasal oxytocin treatment for autism spectrum disorder. Psychiatry Clin Neurosci Dec 12. doi: /pcn [Epub ahead of print] Cheuk DK, Wong V, Chen WX. Acupuncture for autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2011;(9):CD Doi: / CD pub2. Ching H, Pringsheim T. Aripiprazole for autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2012;(5):CD Doi: / CD pub2. Cuomo BM Vaz S, Lee EAL, Thompson C, Rogerson JM, Falkmer T. Effectiveness of sleep-based interventions for children with autism spectrum disorder: A meta-synthesis. Pharmacotherapy. 2017;37(5): Fernandes FD, Amato CA. Applied behavior analysis and autism spectrum disorders: literature review. Codas. 2013;25(3): Ganz ML. The lifetime distribution of the incremental society costs of autism. Arch Pediatr Adolesc Med. 2007;161(4): Hirsch LE, Pringsheim T. Aripiprazole for autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2016;(6):CD Doi: / CD pub3. Horvath A, Lukasik J, Szajewska H. ω-3 Fatty Acid Supplementation Does Not Affect Autism Spectrum Disorder in Children: A Systematic Review and Meta-Analysis. J Nutr. 2017;147(3):

10 Hurwitz R, Blackmore R, Hazell P, Williams K, Woofenden S. Tricyclic antidepressants for autism spectrum disorders (ASD) in children and adolescents. Cochrane Database Syst Rev. 2012;14(3):CD Doi: / CD pub2. Jobski K, Hofer J, Hoffmann F, Bachmann C. Use of psychotropic drugs in patients with autism spectrum disorders: a systematic review. Acta Psychiatr Scand. 2017;135(1):8 28. Lee MS, Choi TY, Sin BC, Ernst E. Acupuncture for children with autism spectrum disorders: a systematic review of randomized clinical trials. J Autism Dev Disord. 2012;42(8): Lee MS, Kim JI, Ernst E. Massage therapy for children with autism spectrum disorders: a systematic review. J Clin Psychiatry. 2011;72(3): Mazahery H, Stonehouse W, Delshad M, et al. Relationship between long chain n-3 polyunsaturated fatty acids and autism spectrum disorder: systematic review and meta-analysis of case-control and Randomised Controlled Trials. Nutrients Feb 19;9(2). pii: E155. doi: /nu Mortimer R, Privopoulos M, Kumar S. The effectiveness of hydrotherapy in the treatment of social and behavioral aspects of children with autism spectrum disorders: a systematic review. J Multidiscip Healthc. 2014;7: Myers SM, Johnson CP, American Academy of Pediatrics (AAP) Council on Children with Disabilities. Management of children with autism spectrum disorders. Pediatrics. 2007;120(5): Preti A, Melis M, Siddi S, et al. Oxytocin and autism: a systematic review of randomized controlled trials. J Child Adolesc Phychopharmacol. 2014;24(2): Rossignol DA, Bradstreet JJ, Van Dyke K, et al. Hyperbaric oxygen treatment in autism spectrum disorders. Med Gas Res. 2012;2(1):16. Doi: / Roy A, Roy M, Deb S, Unwin G, Roy A. Are opioid antagonists effective in attenuating the core symptoms of autism spectrum conditions in children: a systematic review. J intellect Disabil Res. 2015a;59(4): Roy A, Roy M, Deb S, Unwin G, Roy A. Are opioid antagonists effective in reducing self-injury in adults with intellectual disability? A systematic review. J Intellect Disabil Res. 2015b;59(1): Strauss K, Mancini F, SPC Group, Fava L. Parent inclusion in early intensive behavior interventions for young children with ASD: a synthesis of meta-analyses from 2009 to Res Dev Disabil. 2013;34(9):

11 Sturman N, Deckx L, van Driel ML. Methylphenidate for children and adolescents with autism spectrum disorder. Cochrane Database Syst Rev. 2017;11:CD Doi: / CD pub2. Vasa RA, Carroll LM, Nozzolillo AA, et al. A systematic review of treatments for anxiety in youth with autism spectrum disorders. J Autism Dev Disord. 2014;44(12): Virues-Ortega J. Applied behavior analytic intervention for autism in early childhood: meta-analysis, meta-regression and dose-response meta-analysis of multiple outcomes. Clin Psychol Rev. 2010;30(4): Vohra R, Madhavan S, Sambamoorthi U. Comobridity prevalence, healthcare utilization, and expenditures of Medicaid enrolled adults with autism spectrum disorders. Autism. 2017;21(8): Weinmann S, Schwarzbach C, Begemann M, et al. Behavioural and skill-based early interventions in children with autism spectrum disorders. GMS Health Technol Assess. July Doi: /hta Weitlauf AS, Sathe N, McPheeters ML, Warren ZE. Interventions targeting sensory challenges in autism spectrum disorder: a systematic review. Pediatrics. 2017;139(6): Doi: /peds Weston L, Hodgekins J, Langdon PE. Effectiveness of cognitive behavioural therapy with people who have autistic spectrum disorders: a systematic review and meta-analysis. Clin Psychol Rev. 2016;49: Williams K, Wray JA, Wheeler DM. Intravenous secretin for autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2012;(4):CD CMS National Coverage Determinations (NCDs): No NCDs identified as of the writing of this policy. Local Coverage Determinations (LCDs): No LCDs identified as of the writing of this policy. Commonly submitted codes Below are the most commonly submitted codes for the service(s)/item(s) subject to this policy. This is not an exhaustive list of codes. Providers are expected to consult the appropriate coding manuals and bill accordingly. 11

12 CPT Code Description Comments Picture exchange communication system Heath and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; initial assessment Heath and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; re-assessment Health and behavior intervention, each 15 minutes, face-to-face; individual Health and behavior intervention, each 15 minutes, face-to-face; group (2 or more pts) Health and behavior intervention, each 15 minutes, face-to-face; family with patient present Health and behavior intervention, each 15 minutes, face-to-face; family without patient present Occupational therapy evaluation, low to high complexity Re-evaluation of occupational therapy established plan of care Sensory integration 0359T Behavior identification assessment, by the physician or other qualified health care professional, face-to-face with patient and caregiver(s), includes administration of standardized and non-standardized tests, detailed behavioral history, patient observation and caregiver interview, interpretation of test results, discussion of findings and recommendations with the primary guardian(s)/caregiver(s) and preparation of report 0360T Observational behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by one technician; first 30 minutes of technician time, face-to-face with the patient +0361T -each additional 30 minutes of technician time, face-to-face, with the patient 0362T Exposure behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by physician or other qualified health care professional with the assistance of one or more technicians; fir 30 minutes of technician(s) time, face-to-face with patient +0363T -each additional 30 minutes of technician time, face-to-face, with the patient 0364T Adaptive behavior treatment by protocol, administered by technician, face-to-face with one patient; first 30 minutes of technician time +0365T -each additional 30 minutes of technician time 0366T Group adaptive behavior treatment by protocol, administered by technician, faceto-face with two or more patients; first 30 minutes of technician time +0367T -each additional 30 minutes of technician time 0368T Adaptive behavior treatment with protocol modification administered by physician or other qualified health care professional with one patient; first 30 minutes of patient face-to-face time +0369T -each additional 30 minutes of technician time 0370T Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present) 0371T Multiple-family group adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without patient present) 12

13 CPT Code Description Comments 0372T Adaptive behavior treatment social skills group, administered by physician or other qualified health care professional face-to-face with multiple patients Numerous physical and occupational therapies not specified by policy. ICD-10 Code Description Comments F84.0 Autism spectrum disorder HCPCS Level II Code N/A Description Comments 13