| Procedure Code | Procedure Description | Pricing Indicator | Rate Type | Mod1 | Mod2 | Mod3 | Mod4 | Max Fee | Max Fee Eff. Date | Max Fee End Date | PA |
| 97151 | BHV ID ASSMT BY PHYS/QHP | MAXFEE | ABA | 13.84 | 4/1/2021 | 12/31/2299 | N | ||||
| 97151 | BHV ID ASSMT BY PHYS/QHP | PRXOVR | ABA | NA | NA | NA | N | ||||
| 97152 | BHV ID SUPRT ASSMT BY 1 TECH | MAXFEE | ABA | 11.76 | 4/1/2021 | 12/31/2299 | N | ||||
| 97152 | BHV ID SUPRT ASSMT BY 1 TECH | PRXOVR | ABA | NA | NA | NA | N | ||||
| 97153 | ADAPTIVE BEHAVIOR TX BY TECH | MAXFEE | ABA | 12.69 | 4/1/2021 | 12/31/2299 | Y | ||||
| 97153 | ADAPTIVE BEHAVIOR TX BY TECH | PRXOVR | ABA | NA | NA | NA | Y | ||||
| 97154 | GRP ADAPT BHV TX BY TECH | MAXFEE | ABA | 6.35 | 4/1/2021 | 12/31/2299 | Y | ||||
| 97154 | GRP ADAPT BHV TX BY TECH | PRXOVR | ABA | NA | NA | NA | Y | ||||
| 97155 | ADAPT BEHAVIOR TX PHYS/QHP | MAXFEE | ABA | 16.60 | 4/1/2021 | 12/31/2299 | Y | ||||
| 97155 | ADAPT BEHAVIOR TX PHYS/QHP | PRXOVR | ABA | NA | NA | NA | Y | ||||
| 97156 | FAM ADAPT BHV TX GDN PHY/QHP | MAXFEE | ABA | 16.60 | 4/1/2021 | 12/31/2299 | Y | ||||
| 97156 | FAM ADAPT BHV TX GDN PHY/QHP | PRXOVR | ABA | NA | NA | NA | Y | ||||
| 97157 | MULT FAM ADAPT BHV TX GDN | MAXFEE | ABA | 14.11 | 4/1/2021 | 12/31/2299 | Y | ||||
| 97157 | MULT FAM ADAPT BHV TX GDN | PRXOVR | ABA | NA | NA | NA | Y | ||||
| 97158 | GRP ADAPT BHV TX BY PHY/QHP | MAXFEE | ABA | 7.30 | 4/1/2021 | 12/31/2299 | Y | ||||
| 97158 | GRP ADAPT BHV TX BY PHY/QHP | PRXOVR | ABA | NA | NA | NA | Y |