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Health behavior intervention services encompass a range of techniques aimed at enhancing an individual's health, functionality, and treatment outcomes. These interventions may involve cognitive, behavioral, social, psychophysiological, or other methodologies tailored to address specific health challenges. The primary goals of these services include reducing the frequency and severity of disease-related issues, alleviating psychological barriers that hinder effective management of health conditions, and promoting overall well-being. Such interventions are typically delivered by qualified healthcare professionals who possess specialized training in health and behavior interventions, including but not limited to physicians, psychologists, advanced practice nurses, and clinical social workers. Each intervention is customized based on a separately reportable assessment of the individual's needs. The techniques employed during these interventions may include educational components that address biopsychosocial factors affecting health, stress reduction strategies such as relaxation exercises and guided imagery, and fostering social support through group discussions. Additionally, the development of essential social skills and training in new management and coping strategies are integral to the process. Active participation from the patient is encouraged, with a focus on overcoming specific challenges related to their health condition. Family involvement is also a critical aspect of these interventions, particularly when family dynamics contribute to the patient's health issues. Providers may facilitate improvements in communication, conflict resolution, and problem-solving skills among family members through direct instruction and interpersonal communication exercises that can be practiced at home. For parents of young children, behavior modification techniques such as praise and reward systems or distraction methods to alleviate fear and anxiety may be taught. In the context of terminally ill patients, caregivers may receive guidance and support aimed at enhancing communication, monitoring pain, and addressing concerns related to end-of-life issues. The coding for these services is structured to reflect the duration and context of the intervention, with specific codes designated for initial and additional time spent in family face-to-face interactions, both with and without the patient present.
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The health behavior intervention services are indicated for a variety of situations where behavioral and psychological factors significantly impact health outcomes. These may include:
The procedure for health behavior intervention services involves several key steps that ensure effective delivery of care. Each step is designed to facilitate the intervention process and enhance patient and family engagement.
Post-procedure care for health behavior intervention services involves ongoing support and monitoring of the patient’s progress. Providers may schedule follow-up appointments to assess the effectiveness of the intervention and make necessary adjustments to the treatment plan. It is essential to maintain open lines of communication with both the patient and family members to ensure that the strategies implemented are yielding positive outcomes. Additionally, providers may offer resources or referrals to other services as needed to support the patient’s overall health and well-being. Continuous engagement and reinforcement of the techniques learned during the intervention are critical for long-term success in managing health-related challenges.
| Short Descr | HLTH BHV IVNTJ FAM W/O PT EA | Medium Descr | HEALTH BEHAVIOR IVNTJ FAM W/O PT F2F EA ADDL 15 | Long Descr | Health behavior intervention, family (without the patient present), face-to-face; each additional 15 minutes (List separately in addition to code for primary service) | Status Code | Non-Covered Service | Global Days | ZZZ - Code Related to Another Service | 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 | 2 |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 96170 | Telehealth Service (Medicare) 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; 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) |
| GW | Service not related to the hospice patient's terminal condition | 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. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m 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. | AH | Clinical psychologist | CR | Catastrophe/disaster related | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | 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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