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The CPT® Code 96156 refers to a health behavior assessment or re-assessment, which is a structured evaluation conducted by qualified health care professionals, including physicians, psychologists, advanced practice nurses, or clinical social workers, who possess specialized training in health and behavior assessment. This assessment is crucial for identifying biopsychosocial factors that may influence a patient's physical health issues and their management or treatment, particularly in individuals suffering from acute or chronic illnesses or disabilities. During the assessment, the patient undergoes a comprehensive interview that covers their medical, emotional, and social history, as well as their adherence to treatment protocols. The healthcare professional evaluates the patient's outlook, motivation, and capacity to handle challenges associated with their health condition. To gather further insights, standardized questionnaires are utilized to assess various factors such as anxiety, pain levels, coping strategies, and other elements that may contribute to the patient's overall health status. Additionally, the clinician makes observations regarding the patient's reactions to their illness or physical condition, their coping mechanisms, and their understanding of the health issue at hand. The primary objective of the assessment or re-assessment is to identify complicating factors that may hinder the patient's condition or its treatment, thereby informing the development of a tailored plan aimed at enhancing the patient's well-being through psychosocial interventions that address the specific challenges they face related to their health condition.
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The health behavior assessment or re-assessment (CPT® Code 96156) is indicated for patients who present with various health-related challenges. These may include:
The procedure for conducting a health behavior assessment or re-assessment involves several key steps, which are detailed as follows:
After the health behavior assessment or re-assessment is completed, the patient may be provided with recommendations for follow-up care and interventions based on the assessment findings. The healthcare professional may suggest ongoing monitoring of the patient's progress, additional assessments if necessary, and the implementation of psychosocial strategies to support the patient's health management. It is important for the patient to engage in the recommended interventions and maintain open communication with their healthcare provider to ensure optimal outcomes.
| Short Descr | HLTH BHV ASSMT/REASSESSMENT | Medium Descr | HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT | Long Descr | Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making) | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Codes That May Be Paid Through a Composite APC | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
| GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | AH | Clinical psychologist | GC | This service has been performed in part by a resident under the direction of a teaching physician | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | FQ | The service was furnished using audio-only communication technology | GW | Service not related to the hospice patient's terminal condition | Q3 | Live kidney donor surgery and related services | GP | Services delivered under an outpatient physical therapy plan of care | CR | Catastrophe/disaster related | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 93 | Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system : synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located away at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. | AG | Primary physician | AJ | Clinical social worker | AM | Physician, team member service | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GN | Services delivered under an outpatient speech language pathology plan of care | GT | Via interactive audio and video telecommunication systems | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GZ | Item or service expected to be denied as not reasonable and necessary | HL | Intern | HO | Masters degree level | HW | Funded by state mental health agency | KX | Requirements specified in the medical policy have been met | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | SA | Nurse practitioner rendering service in collaboration with a physician | U1 | Medicaid level of care 1, as defined by each state | U3 | Medicaid level of care 3, as defined by each state | U7 | Medicaid level of care 7, as defined by each state | UB | Medicaid level of care 11, as defined by each state | X1 | Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2020-01-01 | Added | Code added. |
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