CPT® Code 97156

Official Description

Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes

Common Language Description

Family adaptive behavior treatment guidance, as defined by CPT® Code 97156, involves a structured interaction between a physician or other qualified healthcare professional and the guardians or caregivers of a patient. This guidance is delivered face-to-face, which may or may not include the patient. The primary objective of this treatment is to equip family members, guardians, or caregivers with the necessary skills and knowledge to implement specific treatment protocols aimed at addressing maladaptive or deficient behaviors exhibited by the patient. These behaviors may include challenges in social interactions, emotional regulation, communication difficulties, or the presence of repetitive, harmful, or stereotypical actions.

During these sessions, the healthcare professional engages with the family to identify target skills that need to be developed or improved. This collaborative approach allows for a tailored treatment plan that focuses on the unique needs of the patient. The professional may utilize various methods, such as role-playing or practical demonstrations, to illustrate how caregivers can effectively support the patient in daily activities. Additionally, caregivers are trained on the use of prompts and reinforcements, which may involve tools like flashcards, gestures, or other communicative signals that have specific meanings.

Furthermore, the healthcare provider ensures that caregivers understand the importance of maintaining the integrity of communication during interactions with the patient. This includes honoring the demonstration of target skills and providing consistent feedback. To support the ongoing treatment process, the professional also supplies written treatment reviews and data collection protocols, which help caregivers track progress and understand the effectiveness of the strategies being implemented. Each session of family adaptive behavior treatment guidance is billed in 15-minute increments, allowing for flexibility in the duration of the guidance provided.

1. Indications

The indications for family adaptive behavior treatment guidance (CPT® Code 97156) include the following:

Behavioral Deficits The procedure is indicated for patients exhibiting maladaptive behaviors that require targeted intervention, such as social, emotional, or communication challenges.
Caregiver Support It is essential for caregivers or guardians to receive training and guidance to effectively support the patient in implementing treatment protocols.
Skill Development The treatment aims to develop specific skills in the patient that address identified behavioral deficits, including repetitive or harmful behaviors.

2. Procedure

The procedure for family adaptive behavior treatment guidance involves several key steps, which are detailed below:

Step 1: Initial Assessment The healthcare professional begins by assessing the patient's specific behavioral challenges and identifying the target skills that need to be developed. This assessment may involve discussions with the caregivers to understand the context of the behaviors and the goals of treatment.
Step 2: Training Session During the face-to-face session, the professional engages with the caregivers, providing them with training on how to implement the treatment protocols. This may include role-playing scenarios to demonstrate effective techniques and strategies for managing the patient's behaviors.
Step 3: Use of Tools Caregivers are instructed on the use of various tools, such as flashcards or gestures, to facilitate communication and reinforce desired behaviors. The professional emphasizes the importance of consistency in using these tools during interactions with the patient.
Step 4: Observation and Feedback The healthcare provider observes the caregivers as they implement the strategies in real-time, offering constructive feedback to enhance their effectiveness. This step is crucial for ensuring that caregivers feel confident in their ability to support the patient.
Step 5: Documentation Finally, the professional provides written treatment reviews and data collection protocols to the caregivers. This documentation serves as a reference for tracking the patient's progress and understanding the impact of the treatment strategies over time.

3. Post-Procedure

Post-procedure care for family adaptive behavior treatment guidance includes ongoing support and follow-up sessions as needed. Caregivers are encouraged to continue practicing the skills learned during the training sessions and to maintain open communication with the healthcare professional regarding the patient's progress. Regular check-ins may be scheduled to assess the effectiveness of the strategies being implemented and to make any necessary adjustments to the treatment plan. Additionally, caregivers should document any changes in the patient's behavior and report these observations during subsequent sessions to ensure that the treatment remains aligned with the patient's evolving needs.

Short Descr	FAM ADAPT BHV TX GDN PHY/QHP
Medium Descr	FAMILY ADAPT BHV TX GDN PHYS/QHP EA 15 MIN
Long Descr	Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), 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

HO	Masters degree level
GT	Via interactive audio and video telecommunication systems
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