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Health behavior intervention services encompass a range of techniques aimed at enhancing an individual's health, functionality, and treatment outcomes. These interventions are tailored to address specific health-related challenges faced by the patient. The services may involve cognitive, behavioral, social, psychophysiological, or other methodologies designed to mitigate the frequency and severity of disease-related issues, reduce psychological barriers to effective condition management, and ultimately promote overall well-being. Qualified health care professionals, including physicians, psychologists, advanced practice nurses, and clinical social workers, who possess specialized training in health and behavior interventions, are authorized to deliver these services. Each intervention is customized based on a comprehensive assessment of the individual patient, ensuring that the techniques employed are relevant and effective. Common strategies utilized in these interventions may include education on biopsychosocial factors that impact health, stress reduction methods such as relaxation techniques and guided imagery, fostering social support through group discussions, enhancing social skills, and training patients in new management and coping strategies. The focus of these services is on encouraging active participation from the patient in interventions that specifically target the challenges associated with their health condition. For billing purposes, CPT® Code 96158 is used to report the first 30 minutes of individual, face-to-face intervention services, while CPT® Code 96159 is designated for each additional 15 minutes of service provided.
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The health behavior intervention services represented by CPT® Code 96159 are indicated for patients who require assistance in managing health-related challenges. These may include, but are not limited to, the following conditions:
The procedure for delivering health behavior intervention services involves several key steps that ensure the effectiveness of the intervention. Each step is designed to facilitate a comprehensive approach to patient care.
After the completion of health behavior intervention services, it is essential to provide follow-up care and support. Patients may be encouraged to continue practicing the techniques learned during the sessions to reinforce their benefits. Additionally, ongoing monitoring of the patient's health and psychological status is recommended to ensure sustained improvement. Healthcare professionals may also provide resources for further support, such as referrals to support groups or additional counseling services, to assist patients in maintaining their health and well-being.
| Short Descr | HLTH BHV IVNTJ INDIV EA ADDL | Medium Descr | HEALTH BEHAVIOR IVNTJ INDIV F2F EA ADDL 15 MIN | Long Descr | Health behavior intervention, individual, face-to-face; each additional 15 minutes (List separately in addition to code for primary service) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | 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 | Items and Services Packaged into APC Rates | Berenson-Eggers TOS (BETOS) | none | MUE | 4 |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 96158 | Telehealth Service (Medicare) Audio-Only Telemedicine (AMA) Telemedicine Service (AMA) MPFS Status: Active Code APC Q3 Health behavior intervention, individual, face-to-face; initial 30 minutes | 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) |
| 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. | CR | Catastrophe/disaster related | 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. | AH | Clinical psychologist | GC | This service has been performed in part by a resident under the direction of a teaching physician | GT | Via interactive audio and video telecommunication systems | FQ | The service was furnished using audio-only communication technology | GW | Service not related to the hospice patient's terminal condition | 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 | GZ | Item or service expected to be denied as not reasonable and necessary | 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. | 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. | AJ | Clinical social worker | 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 | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | HO | Masters degree level | HP | Doctoral level | 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 | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 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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