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Health behavior intervention services, as defined by CPT® Code 96158, are specialized therapeutic techniques aimed at enhancing an individual's health, functionality, and treatment outcomes. These interventions may encompass a variety of approaches, including cognitive, behavioral, social, and psychophysiological methods. The primary goal of these services is to address and mitigate disease-related issues, reduce the frequency and severity of such problems, and eliminate psychological barriers that may hinder effective management of health conditions. Furthermore, these interventions are tailored specifically to the individual patient, based on a comprehensive assessment that is separately reportable. The professionals who provide these services can include a range of healthcare practitioners, such as physicians, psychologists, advanced practice nurses, and clinical social workers, all of whom possess specialized training in health and behavior interventions. Techniques employed during these interventions may involve educating patients about the biopsychosocial factors that affect their health, implementing stress reduction strategies like relaxation exercises and guided imagery, encouraging social support through group discussions, enhancing social skills, and training patients in new management and coping strategies. The focus of these services is on fostering active participation from patients in interventions that specifically target the challenges they face related to their health conditions. For billing purposes, CPT® Code 96158 is reported for the initial 30 minutes of individual, face-to-face intervention services, while CPT® Code 96159 is used for each additional 15 minutes of service provided.
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The health behavior intervention services represented by CPT® Code 96158 are indicated for patients who require assistance in managing health-related issues that may be influenced by psychological, social, or behavioral factors. These services are particularly beneficial for individuals facing challenges such as:
The procedure for delivering health behavior intervention services under CPT® Code 96158 involves several key steps that ensure a comprehensive and individualized approach to patient care. Each step is designed to facilitate effective intervention and support for the patient.
After the initial 30-minute intervention session, it is essential to evaluate the patient's response to the intervention and make any necessary adjustments to the treatment plan. Follow-up sessions may be scheduled to continue the intervention, with additional time billed using CPT® Code 96159 for each subsequent 15 minutes of service. Ongoing support and reinforcement of the strategies learned during the intervention are critical for ensuring long-term success in managing health-related challenges. Documentation of the intervention, including the techniques used and the patient's progress, is also important for compliance and future treatment planning.
| Short Descr | HLTH BHV IVNTJ INDIV 1ST 30 | Medium Descr | HEALTH BEHAVIOR IVNTJ INDIV F2F 1ST 30 MIN | Long Descr | Health behavior intervention, individual, face-to-face; initial 30 minutes | 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 |
This is a primary code that can be used with these additional add-on codes.
| 0770T | Add-on Code MPFS Status: Carrier Priced APC E1 Virtual reality technology to assist therapy (List separately in addition to code for primary procedure) | 96159 | Telehealth Service (Medicare) Add-on Code Audio-Only Telemedicine (AMA) Telemedicine Service (AMA) MPFS Status: Active Code APC N Health behavior intervention, individual, face-to-face; each additional 15 minutes (List separately in addition to code for primary service) |
| 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 | KX | Requirements specified in the medical policy have been met | GT | Via interactive audio and video telecommunication systems | CR | Catastrophe/disaster related | FQ | The service was furnished using audio-only communication technology | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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. | 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. | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | Q3 | Live kidney donor surgery and related services | 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. | 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. | 97 | Rehabilitative services: when a service or procedure that may be either habilitative or rehabilitative in nature is provided for rehabilitative purposes, the physician or other qualified health care professional may add modifier 97 to the service or procedure code to indicate that the service or procedure provided was a rehabilitative service. rehabilitative services help an individual keep, get back, or improve skills and functioning for daily living that have been lost or impaired because the individual was sick, hurt, or disabled. | AJ | Clinical social worker | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CS | Cost-sharing waived for specified covid-19 testing-related services that result in and order for or administration of a covid-19 test and/or used for cost-sharing waived preventive services furnished via telehealth in rural health clinics and federally qualified health centers during the covid-19 public health emergency | FS | Split (or shared) evaluation and management visit | GP | Services delivered under an outpatient physical therapy plan of care | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | 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 | HN | Bachelors degree level | HP | Doctoral level | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | U5 | Medicaid level of care 5, as defined by each state | 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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