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Health behavior intervention services, as defined by CPT® Code 96164, involve structured group sessions aimed at enhancing the health and well-being of participants through various therapeutic techniques. These interventions may encompass cognitive, behavioral, social, and psychophysiological strategies tailored to address specific health-related challenges faced by individuals. The primary goal of these services is to improve health outcomes, enhance functional abilities, and reduce the impact of disease-related issues. Additionally, these interventions seek to alleviate psychological barriers that may hinder effective management of health conditions, ultimately fostering a better quality of life for participants. The services are delivered by qualified healthcare professionals, including physicians, psychologists, advanced practice nurses, and clinical social workers, all of whom possess specialized training in health and behavior interventions. Each intervention is customized based on a separately reportable assessment, ensuring that the techniques employed—such as education on biopsychosocial factors, stress reduction methods, social support engagement, and skill development—are relevant and beneficial to the group. The focus is on encouraging active participation from patients, empowering them to tackle the specific challenges associated with their health conditions. For the initial 30 minutes of these face-to-face group intervention services involving two or more patients, the appropriate code to report is 96164, while 96165 should be used for each additional 15 minutes of service provided.
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The health behavior intervention services represented by CPT® Code 96164 are indicated for patients who require support in managing health-related challenges. These may include, but are not limited to, the following conditions:
The procedure for delivering health behavior intervention services under CPT® Code 96164 involves several key steps that ensure effective group engagement and support. Each step is designed to facilitate a structured environment conducive to patient participation and learning.
Post-procedure care following the health behavior intervention involves ongoing support and potential follow-up sessions to reinforce the strategies learned during the initial intervention. Participants may be encouraged to practice the techniques discussed, such as stress management and social skills development, in their daily lives. Additionally, healthcare professionals may provide resources or referrals for further assistance, ensuring that patients continue to receive the support necessary to manage their health effectively. Monitoring progress and addressing any emerging challenges are essential components of the post-procedure phase, contributing to the overall success of the intervention.
| Short Descr | HLTH BHV IVNTJ GRP 1ST 30 | Medium Descr | HEALTH BEHAVIOR IVNTJ GROUP F2F 1ST 30 MIN | Long Descr | Health behavior intervention, group (2 or more patients), 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) | 96165 | Telehealth Service (Medicare) Add-on Code Resequenced Code Audio-Only Telemedicine (AMA) Telemedicine Service (AMA) MPFS Status: Active Code APC N Health behavior intervention, group (2 or more patients), 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. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | CR | Catastrophe/disaster related | GT | Via interactive audio and video telecommunication systems | 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 | 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. | 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. | AH | Clinical psychologist | GZ | Item or service expected to be denied as not reasonable and necessary | KX | Requirements specified in the medical policy have been met | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | 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 |
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| 2020-01-01 | Added | Code added. |
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