Health Behavior Assessment Services Assessment or reassessment Demystified
All providers should become familiar with the new codes so you know when and how to use them. Be sure you coordinate with your billing support or vendors, including your billing software vendor or Electronic Data Interchange (EDI) clearinghouse, to make sure they are ready.
- CPT code 96156 is used to describe health behavior assessment, or re-assessment, that is conducted through health-focused clinical interviews, observation and clinical decision-making.
- Assessment services are now event-based and CPT code 96156 is billed only once per day regardless of the amount of time required to complete the overall service.
- Only report 96156 for assessment of a patient with a primary diagnosis that is physical in nature.
- Do not report 96156 on the same day as psychiatric services (90785-90899) or adaptive behavior services (97151-97158, 0362T, 0373T).
- For patients that require psychiatric services or adaptive behavior services, as well as health behavior assessment/intervention, report the
predominant service performed.
- Evaluation and Management (E/M) services codes, including counseling risk factor reduction and behavior change intervention (99401-99412),
should not be reported on the same day as health behavior assessment and intervention codes by the same provider:
- These services can occur and be reported on the same date of service as long as the E/M service (99401-99412) is performed by a physician or
other qualified health care professional (QHP) who may report evaluation and management services.
- However, health behavior assessment and/or intervention services performed by a physician or other QHP who may report E/M services
should do so using codes found in the E/M Services or Preventive Medicine Services sections of the CPT® Manual.
Guidelines: Health and Behavior Assessment/Intervention services (96156, 96158, 96159, 96164, 96165, 96167, 96168, 96170, 96171)
- These codes are used to report services provided face-to-face by a physician or other qualified health care professional for the purpose of promoting health and preventing illness or injury. They are distinct from evaluation and management (E/M) services that may be reported separately when performed. Risk factor reduction services are used for persons without a specific illness for which the counseling might otherwise be used as part of treatment.
- Preventive medicine counseling and risk factor reduction interventions will vary with age and should address such issues as family problems, diet and exercise, substance use, sexual practices, injury prevention, dental health, and diagnostic and laboratory test results available at the time of the encounter.
- Behavior change interventions are for persons who have a behavior that is often considered an illness itself, such as tobacco use and addiction, substance abuse/misuse, or obesity. Behavior change services may be reported when performed as part of the treatment of condition(s) related to or potentially exacerbated by the behavior or when performed to change the harmful behavior that has not yet resulted in illness. Any E/M services reported on the same day must be distinct, and time spent providing these services may not be used as a basis for the E/M code selection. Behavior change services involve specific validated interventions of assessing readiness for change and barriers to change, advising a change in behavior, assisting by providing specific suggested actions and motivational counseling, and arranging for services and follow-up.
- For counseling groups of patients with symptoms or established illness, use 99078.
- Health and Behavior Assessment/Intervention services (96156, 96158, 96159, 96164, 96165, 96167, 96168, 96170, 96171) should not be reported on the same day as codes 99401–99412.
See below for a rate table listing reimbursement rates
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