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Health behavior intervention services, as defined by CPT® Code 96167, involve structured techniques aimed at enhancing a patient's health, functionality, and treatment outcomes. These interventions may encompass a variety of approaches, including cognitive, behavioral, social, and psychophysiological methods. The primary goal is to alleviate the frequency and severity of problems associated with diseases, address psychological barriers that hinder effective management of health conditions, and ultimately promote overall well-being. Such services are tailored to the individual based on a comprehensive assessment that is reported separately. Qualified healthcare 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. The interventions are designed to actively engage the patient, focusing on specific challenges related to their health condition. Family involvement is a critical component, particularly when family dynamics contribute to the patient's health issues. During these interventions, providers may facilitate improved communication, conflict resolution, and problem-solving skills among family members, offering guidance and exercises that can be practiced at home. For parents of young children, behavior modification techniques such as praise and reward systems or distraction methods may be employed to alleviate fear and anxiety. In the context of terminally ill patients, caregivers may receive essential instruction and support regarding communication, pain management, and navigating the complexities surrounding end-of-life issues. The initial 30 minutes of face-to-face family intervention with the patient present is reported using code 96167, while additional time is reported with 96168. For family interventions without the patient present, the initial 30 minutes is reported with 96170, and each additional 15 minutes is reported with 96171.
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The health behavior intervention services represented by CPT® Code 96167 are indicated for various situations where the patient's health issues are influenced by behavioral, psychological, or social factors. These indications may include, but are not limited to:
The procedure for health behavior intervention services under CPT® Code 96167 involves several key steps that ensure effective delivery of care. Each step is designed to facilitate the patient's engagement and address specific health-related challenges.
After the initial health behavior intervention session, it is expected that the patient and their family will continue to engage in the strategies and techniques discussed during the encounter. Follow-up sessions may be scheduled to assess progress, address any ongoing challenges, and provide additional support as needed. The healthcare provider may also recommend specific activities or exercises for the family to practice at home, reinforcing the skills learned during the intervention. Continuous communication and support are essential to ensure that the patient and family can effectively manage the health-related issues addressed during the intervention.
| Short Descr | HLTH BHV IVNTJ FAM 1ST 30 | Medium Descr | HEALTH BEHAVIOR IVNTJ FAM W/PT F2F 1ST 30 MIN | Long Descr | Health behavior intervention, family (with the patient present), 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) | 96168 | Telehealth Service (Medicare) Add-on Code Resequenced Code Audio-Only Telemedicine (AMA) Telemedicine Service (AMA) MPFS Status: Active Code APC N Health behavior intervention, family (with the patient present), 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. | GT | Via interactive audio and video telecommunication systems | GZ | Item or service expected to be denied as not reasonable and necessary | AJ | Clinical social worker | 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. | 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 | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | 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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