CPT® Code 97151

Official Description

Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan

Common Language Description

The CPT® Code 97151 refers to a behavior identification assessment that is conducted by a physician or another qualified healthcare professional. This assessment is designed to identify and evaluate deficient or maladaptive behaviors, as well as the associated impaired functioning that may arise from these behaviors. The assessment process is comprehensive and involves both face-to-face interactions with the patient and/or their guardians or caregivers, as well as non-face-to-face activities that include analyzing past data, scoring and interpreting the assessment results, and preparing a detailed report or treatment plan.

Deficient behaviors may encompass issues related to social or communication skills, while maladaptive behaviors can include repetitive, harmful, or stereotypic actions. The impact of these behaviors can lead to significant impairments in functioning, which may manifest as difficulties in verbal or nonverbal communication, challenges in self-care for daily tasks, and an inability to follow instructions or engage in social interactions, play, or imitation. In some cases, these behaviors may even pose risks of personal harm or harm to others.

The assessment may utilize a variety of methods, including both standardized and non-standardized instruments. For instance, tools like The Vineland Adaptive Behavior Scale are often employed to measure personal and social skills across four key domains: communication, daily living, socialization, and motor skills. Additionally, the healthcare professional may conduct functional behavioral assessments to pinpoint environmental factors that trigger specific target behaviors. This process may involve repeated presentations and withdrawals of environmental events to evaluate their individual effects. Furthermore, interviews with guardians or caregivers are integral to gathering comprehensive behavioral history and relevant clinical data.

Overall, the behavior identification assessment encapsulated by CPT® Code 97151 is a critical component in understanding and addressing behavioral challenges, ultimately leading to the development of effective care plans tailored to the needs of the patient.

1. Indications

The behavior identification assessment, as described by CPT® Code 97151, is indicated for patients exhibiting a range of behavioral concerns that may impact their daily functioning. The following conditions or symptoms may warrant this assessment:

Deficient Social Skills Patients may struggle with social interactions, demonstrating difficulties in engaging with peers or understanding social cues.
Communication Challenges Individuals may exhibit limited verbal or nonverbal communication abilities, affecting their ability to express needs or understand others.
Maladaptive Behaviors This includes repetitive, harmful, or stereotypic behaviors that may interfere with daily activities or pose risks to the individual or others.
Impaired Daily Functioning Patients may have trouble with self-care tasks, following instructions, or participating in play and socialization activities.
Behavioral Concerns Leading to Harm Situations where behaviors may result in personal harm or harm to others necessitate a thorough assessment to develop appropriate interventions.

2. Procedure

The procedure for conducting a behavior identification assessment under CPT® Code 97151 involves several key steps that ensure a comprehensive evaluation of the patient's behavioral concerns. Each step is crucial for gathering the necessary information to inform treatment planning.

Step 1: Review of Clinical Data The healthcare professional begins by reviewing relevant personal clinical data and behavioral history. This step is essential for understanding the patient's background and any previous interventions that may have been attempted.
Step 2: Administration of Assessments The professional administers standardized or non-standardized instruments, such as The Vineland Adaptive Behavior Scale, to evaluate the patient's personal and social skills across various domains. This may also include specific stimulus preference assessments tailored to the individual.
Step 3: Functional Behavioral Assessment A functional behavioral assessment is performed to identify environmental events that may trigger target behaviors. This involves observing the patient in different settings and situations to gather data on behavior patterns.
Step 4: Data Analysis The healthcare professional analyzes the collected data, scoring and interpreting the results to identify significant findings related to the patient's behaviors and functioning.
Step 5: Report Preparation A detailed report is prepared, summarizing the assessment findings, interpretations, and recommendations for treatment. This report serves as a foundational document for developing a care plan.
Step 6: Discussion with Caregivers Finally, the healthcare professional discusses the findings and recommendations face-to-face with the patient’s primary caregiver or guardian. This step is vital for ensuring that the caregivers understand the assessment results and the proposed interventions.

3. Post-Procedure

After the behavior identification assessment is completed, several post-procedure considerations are important for the ongoing care of the patient. The healthcare professional may provide recommendations for follow-up interventions based on the assessment findings. This could include referrals to additional services, such as behavioral therapy or specialized educational programs. The caregiver or guardian is encouraged to implement strategies discussed during the face-to-face meeting to support the patient’s development and address identified behavioral concerns. Regular follow-up appointments may be scheduled to monitor progress and make necessary adjustments to the treatment plan as the patient’s needs evolve.

Short Descr	BHV ID ASSMT BY PHYS/QHP
Medium Descr	BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN
Long Descr	Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan
Status Code	Carriers Price the 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
Type of Service (TOS)	1 - Medical Care
Berenson-Eggers TOS (BETOS)	none
MUE	8

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.
HO	Masters degree level
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.
AJ	Clinical social worker
GP	Services delivered under an outpatient physical therapy plan of care
GW	Service not related to the hospice patient's terminal condition
XE	Separate encounter, a service that is distinct because it occurred during a separate encounter
XU	Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service