CPT® Code 97158

Official Description

Group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, face-to-face with multiple patients, each 15 minutes

Common Language Description

Adaptive behavior treatment with protocol modification, as described by CPT® Code 97158, involves a structured approach to enhancing the social and communication skills of individuals within a group setting. This treatment is delivered face-to-face by a physician or another qualified healthcare professional who actively observes and monitors the interactions and needs of each participant. The term "adaptive behavior" refers to the skills necessary for individuals to function effectively in their daily lives, particularly in social contexts. The protocol modification aspect indicates that the treatment techniques can be adjusted in real-time based on the dynamics of the group and the specific needs of the individuals present. This flexibility allows the healthcare professional to tailor the session to better address the unique challenges faced by each participant. For instance, during the group sessions, individuals may engage in activities designed to foster peer interaction, such as sharing experiences or participating in discovery exercises. The healthcare professional plays a crucial role in guiding these interactions, helping participants to interpret social cues, offering suggestions for improved communication, and providing constructive feedback. At the conclusion of each session, the professional summarizes the skills practiced and may assign individualized homework to encourage continued development outside of the group setting. It is important to note that CPT® Code 97158 is reported for each 15-minute increment of face-to-face interaction with multiple patients, and this code should not be used if the group exceeds eight participants.

1. Indications

The indications for administering group adaptive behavior treatment with protocol modification (CPT® Code 97158) include the need to enhance social and communication skills among individuals who may struggle with peer interactions. This treatment is particularly beneficial for patients who require support in developing their ability to engage with others in a group setting. Specific indications may include:

Social Skills Deficits Individuals who have difficulty interpreting social cues or engaging in appropriate social interactions.
Communication Challenges Patients who need assistance in expressing themselves effectively within a group context.
Peer Interaction Difficulties Those who struggle to participate in group activities or maintain relationships with peers.
Behavioral Concerns Individuals exhibiting behaviors that hinder their ability to interact positively with others.

2. Procedure

The procedure for group adaptive behavior treatment with protocol modification involves several key steps that ensure effective delivery of the treatment. Each step is designed to facilitate the development of social and communication skills among participants.

Step 1: Group Formation The healthcare professional organizes a group of patients, ensuring that the number of participants does not exceed eight. This allows for effective monitoring and interaction among group members.
Step 2: Initial Assessment Prior to the session, the healthcare professional assesses the individual needs of each participant to tailor the treatment protocol accordingly. This assessment may involve understanding each patient's specific challenges and goals.
Step 3: Implementation of Treatment Protocol During the session, the healthcare professional leads the group in activities designed to promote social interaction and communication. These activities may include role-playing, sharing experiences, or engaging in structured discussions.
Step 4: Real-Time Protocol Modification As the session progresses, the healthcare professional observes the interactions and modifies the treatment techniques as needed. This may involve adjusting activities or providing additional support to individuals who require it.
Step 5: Feedback and Summary At the end of the session, the healthcare professional summarizes the skills practiced and provides feedback to each participant. This includes highlighting successes and areas for improvement.
Step 6: Homework Assignment The healthcare professional assigns individualized homework to each participant, encouraging them to practice the skills learned during the session in their daily lives.

3. Post-Procedure

Post-procedure care for participants involves continued practice of the skills learned during the group session. The healthcare professional may schedule follow-up sessions to monitor progress and make further adjustments to the treatment protocol as necessary. Participants are encouraged to engage in their assigned homework and apply the skills in real-life situations to reinforce learning. Additionally, the healthcare professional remains available to answer any questions or provide further guidance as needed, ensuring that each individual continues to develop their social and communication abilities effectively.

Short Descr	GRP ADAPT BHV TX BY PHY/QHP
Medium Descr	GRP ADAPT BHV PRTCL MODIFCAJ PHYS/QHP EA 15 MIN
Long Descr	Group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, face-to-face with multiple patients, 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

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)