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The CPT® Code 96165 refers to health behavior intervention services conducted in a group setting, specifically for two or more patients, and is billed for each additional 15 minutes of face-to-face interaction. These interventions are designed to enhance health outcomes, improve functionality, and address treatment-related challenges through various techniques. The services may encompass cognitive, behavioral, social, and psychophysiological strategies aimed at fostering better health management and overall well-being. Health behavior interventions are tailored to the unique needs of the participants, based on a comprehensive assessment that is separately reportable. Qualified healthcare professionals, including physicians, psychologists, advanced practice nurses, and clinical social workers, deliver these interventions, utilizing methods such as education on biopsychosocial factors, stress reduction techniques, social support engagement, and skill development. The focus is on encouraging active participation from patients to effectively manage their conditions and improve their quality of life.
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The health behavior intervention services represented by CPT® Code 96165 are indicated for patients who require support in managing health-related challenges. These may include:
The procedure for health behavior intervention services under CPT® Code 96165 involves several key steps, which are detailed as follows:
After the completion of the health behavior intervention sessions, it is essential to provide follow-up care and support to reinforce the skills and strategies learned. Patients may be encouraged to continue practicing the techniques discussed during the sessions in their daily lives. Additionally, ongoing assessments may be conducted to evaluate the effectiveness of the interventions and to determine if further sessions are needed. The overall goal is to ensure that patients feel empowered to manage their health conditions effectively and to maintain the improvements achieved through the intervention.
| Short Descr | HLTH BHV IVNTJ GRP EA ADDL | Medium Descr | HEALTH BEHAVIOR IVNTJ GROUP F2F EA ADDL 15 MIN | Long Descr | Health behavior intervention, group (2 or more patients), 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 | 6 |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 96164 | Telehealth Service (Medicare) Resequenced Code Audio-Only Telemedicine (AMA) Telemedicine Service (AMA) MPFS Status: Active Code APC Q3 Health behavior intervention, group (2 or more patients), 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. | 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. | 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 | AH | Clinical psychologist | GT | Via interactive audio and video telecommunication systems | GC | This service has been performed in part by a resident under the direction of a teaching physician | CR | Catastrophe/disaster related | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | 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. | AJ | Clinical social worker | GZ | Item or service expected to be denied as not reasonable and necessary | 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 | 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 | 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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