January 26, 2017
There continues to be confusion on how to correctly bill the Health and Behavior Assessment/Intervention CPT codes 96150-96155. Per CPT coding guidelines, providers need to know the following key points when submitting these codes:
- These codes/services are intended to be submitted by non-physician practitioners to identify assessment and treatment for biopsychosocial factors affecting a patient’s physical health problems.
- The focus of the assessment is not on mental health but on factors important to physical health problems and treatments.
- These codes describe services associated with an acute or chronic illness (not meeting criteria for psychiatric diagnosis), prevention of a physical illness or disability, and maintenance of health, not meeting criteria for psychiatric diagnosis or representing a preventive medicine service.
- These codes are not intended to be submitted by physicians. Physicians performing these services may identify their efforts by choosing the appropriate Evaluation and Management (E&M) code or Prolonged Services code.
Credentialed providers are urged to bill appropriately with these codes. Review the coding and billing guidelines in a current CPT code book (Medicine code section) or review the March 2002 CPT Assistant article discussing the billing of these codes.