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Health behavior intervention services, as defined by CPT® Code 96168, 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 improve the overall well-being of the patient. Such services are tailored to the individual based on a comprehensive assessment that is separately reportable. The interventions can be delivered by a range of qualified healthcare professionals, including physicians, psychologists, advanced practice nurses, and clinical social workers, all of whom possess specialized training in health and behavior interventions. The techniques employed during these interventions may include educational components that address biopsychosocial factors affecting health, stress reduction strategies such as relaxation techniques and guided imagery, and fostering social support through group discussions. Additionally, the interventions may focus on developing essential social skills and training patients in new management and coping strategies. Family involvement is a critical aspect of these intervention services, particularly when family dynamics contribute to the patient's health challenges. Providers may facilitate improved communication, conflict resolution, and problem-solving skills among family members during these sessions. This may involve instructing family members on managing biopsychosocial factors that impact the care of children or terminally ill patients. For instance, parents of young children may learn behavior modification techniques, such as using praise and rewards or distraction methods to alleviate fear and anxiety. In the context of terminal illness, caregivers may receive guidance on enhancing communication, monitoring pain, and addressing issues related to end-of-life care. To accurately report these services, CPT® Code 96167 is used for the initial 30 minutes of family face-to-face time with the patient present, while CPT® Code 96168 is designated for each additional 15 minutes of such interaction.
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The health behavior intervention services represented by CPT® Code 96168 are indicated for patients who require support in managing health-related challenges that may be exacerbated by psychological, social, or behavioral factors. These interventions are particularly beneficial in the following scenarios:
The procedure for delivering health behavior intervention services under CPT® Code 96168 involves several key steps that ensure effective engagement with the patient and their family. Each step is designed to facilitate a comprehensive approach to health behavior modification.
Post-procedure care following health behavior intervention services involves continued support and monitoring of the patient's progress. Providers may recommend follow-up sessions to reinforce the techniques learned and to address any ongoing challenges. It is important for family members to continue practicing the skills and strategies discussed during the intervention to ensure lasting improvements in communication and health management. Additionally, providers may offer resources or referrals for further support, depending on the patient's needs and circumstances. Regular follow-up appointments can help assess the effectiveness of the interventions and make necessary adjustments to the care plan.
| Short Descr | HLTH BHV IVNTJ FAM EA ADDL | Medium Descr | HEALTH BEHAVIOR IVNTJ FAM W/PT F2F EA ADD 15 MIN | Long Descr | Health behavior intervention, family (with the patient present), 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.
| 96167 | Telehealth Service (Medicare) Resequenced Code Audio-Only Telemedicine (AMA) Telemedicine Service (AMA) MPFS Status: Active Code APC Q3 Health behavior intervention, family (with the patient present), 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. | GT | Via interactive audio and video telecommunication systems | AH | Clinical psychologist | 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. | 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 | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GZ | Item or service expected to be denied as not reasonable and necessary | 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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