CPT® Code 97152

Official Description

Behavior identification-supporting assessment, administered by one technician under the direction of a physician or other qualified health care professional, face-to-face with the patient, each 15 minutes

Common Language Description

A behavior identification-supporting assessment is a specialized evaluation conducted to identify and support the understanding of specific behaviors that may be deficient or maladaptive. This assessment is performed by a behavior technician who operates under the direction of a physician or another qualified healthcare professional. The technician engages with the patient in a face-to-face setting, which can occur in various environments, including clinical or community settings. The primary goal of this assessment is to observe and document occurrences of particular behaviors that may hinder social interactions or communication, or that may manifest as repetitive, harmful, or stereotypic actions. During the assessment, the technician utilizes structured observation techniques and may administer both standardized and non-standardized assessment tools. These tools are designed to gather comprehensive data regarding the target behavior. Additionally, a functional behavior assessment may be conducted to identify the environmental factors that trigger or follow the behavior in question. This involves analyzing the context in which the behavior occurs to better understand its antecedents and consequences. Furthermore, a functional analysis may be performed to systematically evaluate the impact of different environmental events on the behavior by manipulating these variables in controlled situations. The results of the assessment are interpreted by the supervising physician or qualified professional, ensuring that the findings are clinically relevant and actionable. The service is billed in increments of 15 minutes of direct interaction between the technician and the patient, reflecting the time dedicated to this critical evaluative process.

1. Indications

The behavior identification-supporting assessment is indicated for patients exhibiting specific or severely deficient behaviors that may impact their social interactions, communication abilities, or overall functioning. This assessment is particularly relevant for individuals displaying:

Social Deficiencies - Difficulties in engaging with peers or forming relationships.
Communication Deficiencies - Challenges in expressing needs, understanding language, or using appropriate verbal and non-verbal communication.
Repetitive Behaviors - Engagement in actions that are repetitive in nature, which may include hand-flapping, rocking, or other stereotypic movements.
Harmful Behaviors - Actions that pose a risk to the individual or others, such as self-injury or aggression.

2. Procedure

The procedure for conducting a behavior identification-supporting assessment involves several key steps that ensure a comprehensive evaluation of the patient's behavior. Each step is crucial for gathering accurate data and understanding the context of the behaviors observed.

Step 1: Preparation - Prior to the assessment, the behavior technician reviews the patient's history and any previous evaluations to understand the context of the behaviors being assessed. This preparation may include gathering information from caregivers or other professionals involved in the patient's care.
Step 2: Direct Observation - The technician conducts structured observations of the patient in various settings to identify the target behaviors. This may involve watching the patient interact with peers, engage in activities, or respond to different environmental stimuli.
Step 3: Administration of Assessment Tools - The technician employs standardized or non-standardized instruments to gather quantitative and qualitative data about the behaviors. These tools help in measuring the frequency, duration, and intensity of the behaviors observed.
Step 4: Functional Behavior Assessment - A functional behavior assessment is performed to identify the antecedents and consequences of the target behavior. This step involves analyzing what triggers the behavior and what reinforces it, providing insight into the behavior's function.
Step 5: Functional Analysis - The technician may conduct a functional analysis to systematically manipulate environmental variables and observe their effects on the target behavior. This helps in understanding how different situations influence the behavior.
Step 6: Interpretation of Results - After completing the assessment, the supervising physician or qualified professional interprets the results, providing a comprehensive understanding of the patient's behavior and recommendations for intervention.

3. Post-Procedure

Following the behavior identification-supporting assessment, the technician and supervising professional will discuss the findings with the patient and their caregivers. This discussion may include recommendations for behavioral interventions, strategies for addressing the identified behaviors, and potential follow-up assessments. The results of the assessment can inform treatment planning and help in developing individualized support strategies to enhance the patient's social and communication skills. Continuous monitoring and reassessment may be necessary to evaluate the effectiveness of the interventions implemented.

Short Descr	BHV ID SUPRT ASSMT BY 1 TECH
Medium Descr	BEHAVIOR ID SUPPORT ASSMT BY 1 TECH EA 15 MIN
Long Descr	Behavior identification-supporting assessment, administered by one technician under the direction of a physician or other qualified health care professional, face-to-face with the patient, each 15 minutes
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	16

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.
GO	Services delivered under an outpatient occupational therapy plan of care
GP	Services delivered under an outpatient physical therapy plan of care