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Health behavior intervention services, as defined by CPT® Code 96170, are specialized therapeutic approaches aimed at enhancing an individual's health and overall well-being through various techniques. These interventions may encompass cognitive, behavioral, social, and psychophysiological strategies tailored to address specific health challenges. The primary goal of these services is to improve health outcomes, reduce the impact of disease-related issues, and assist individuals in overcoming psychological barriers that may hinder effective management of their conditions. The interventions are designed based on a comprehensive assessment of the individual’s needs and may involve a range of techniques, including education on biopsychosocial factors that affect health, stress reduction methods such as relaxation exercises and guided imagery, and the development of social skills through group discussions. Additionally, family dynamics can significantly influence a patient's health, and thus, family members may be included in the intervention process. This inclusion allows for the enhancement of communication, conflict resolution, and problem-solving skills within the family unit. During these sessions, healthcare professionals provide guidance and exercises that families can practice at home to foster better interactions and support systems. For instance, parents of young children may learn behavior modification techniques to encourage positive behaviors, while caregivers of terminally ill patients may receive support in managing communication and pain monitoring. Overall, these health behavior interventions are structured to actively engage patients and their families in strategies that address the unique challenges posed by their health conditions.
© Copyright 2025 Coding Ahead. All rights reserved.
The health behavior intervention services represented by CPT® Code 96170 are indicated for various situations where family dynamics may exacerbate a patient's health issues. These indications include:
The procedure for health behavior intervention services under CPT® Code 96170 involves several key steps, which are detailed as follows:
After the health behavior intervention session, it is expected that family members will continue to apply the skills and techniques learned during the encounter. Follow-up may be necessary to assess the effectiveness of the intervention and make any needed adjustments. The provider may recommend additional sessions if ongoing support is required, particularly if the family dynamics or the patient's health condition evolves. Documentation of the session, including the techniques taught and the family's participation, is essential for continuity of care and for any future interventions.
| Short Descr | HLTH BHV IVNTJ FAM WO PT 1ST | Medium Descr | HEALTH BEHAVIOR IVNTJ FAM W/O PT F2F 1ST 30 MIN | Long Descr | Health behavior intervention, family (without the patient present), face-to-face; initial 30 minutes | Status Code | Non-Covered Service | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Non-Covered Service, not paid under OPPS | 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) | 96171 | Telehealth Service (Medicare) Add-on Code Resequenced Code Audio-Only Telemedicine (AMA) Telemedicine Service (AMA) MPFS Status: Non-covered Service APC E1 Health behavior intervention, family (without 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. | 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 | CR | Catastrophe/disaster related | 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 | KX | Requirements specified in the medical policy have been met |
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| 2020-01-01 | Added | Code added. |
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