Providing and reporting new Group Caregiver Behavior Management Training Services

Beginning January 1, 2023, psychologists will be able to provide and report Caregiver Behavior Management Training (CBMT), a new group-based service administered to parent(s)/caregiver(s) of patients that have been diagnosed with a physical or mental health condition. CMBT codes allow psychologists and other providers to bill for services that involve training a patient’s parent(s) and/or caregiver(s) in interventions and strategies to help manage or treat the patient’s condition. This type of training can improve clinical outcomes for several mental and physical health conditions. APA developed these new CPT^® codes to fill a problematic coding gap.

A new subsection has been established in the 2023 CPT^® Manual, entitled “Behavior Management Services.” Within the subsection is guidance language related to reporting two new CPT codes (96202 and 96203) which were created to report physician or other qualified health care professional (QHP) administered multiple-family group behavior management or modification training for guardian(s)/caregiver(s), without the patient(s) present. The codes identify the efforts of the physicians/QHPs to train the parent(s)/caregiver(s) regarding intervention methods that they may use to manage a patient’s disease(s)/illness(es).

CBMT services emphasize active engagement and involvement of the parent(s)/guardian(s)/caregiver(s) in the treatment of the patient that has been diagnosed with a physical or mental health condition. The physicians/QHPs train the parent(s)/caregiver(s) on specific evidence-based behavioral management/modification procedures and strategies that will result in the identified patient responding to their circumstances in a more positive way.

Behavioral management/modification can improve clinical outcomes for numerous conditions across the lifespan, including but not limited to: anxiety, asthma, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders, cystic fibrosis, depression, diabetes, eating disorders, elimination disorders, gastrointestinal disorders, kidney disease, neurodegenerative diseases (e.g. Alzheimer’s and other dementias, Parkinson’s, Huntington’s), obesity, obsessive-compulsive disorder, sleep disorders, and substance use disorders.

Coding guidance provided in the new “Behavior Management Services” subsection of the 2023 CPT^® Manual provides a detailed description of CBMT services, and the circumstances in which it is provided (i.e., face-to-face with the caregivers in a multifamily setting, without the patient present, for a specific period of time), and provides references to other services that should be reported when these specific service components are not utilized.

Behavioral training associated with this service requires the clinical expertise of at least one physician or qualified, nonphysician health care professional, who is well versed in evidence-based behavior management/modification procedures and strategies. CBMT is more than simply educating parents/caregivers about the identified patient’s mental and/or physical diagnosis, or how to support self-management, independent living, and activities of daily living. This service teaches specific behavioral management/modification procedures, strategies and interventions that will improve the identified patient’s functioning as well as allow them to better manage the identified patient’s presenting mental or physical health diagnosis.

Codes 96202 and 96203 are used to report the total duration of face-to-face time spent by the physician or other QHP providing group-based parents/ guardians/caregivers behavioral management/modification training services. There is also research that supports providing this service via telehealth. Providing the service via telehealth can remove barriers to treatment attendance commonly found in multisession training programs, reduce travel demands and attrition rates, extend the reach of specialty care experts, and increase patient and parent/caregiver access to treatment.

While this service is performed without the patient present, the goals and outcomes are solely for the therapeutic benefit of the identified patient. The “parent/caregiver only” sessions are conducted to address how they can better manage common mental or physical health conditions as well as help to support compliance with the identified patient’s treatment and the clinical plan of care.

The physician or QHP must rely on their expertise and ability to integrate multiple factors, while effectively capitalizing upon the group dynamics to personalize the intervention and optimize treatment outcomes. During these sessions, the parents/caregivers are trained, using verbal instruction, video and live demonstrations, and feedback from a physician or other qualified health care professional or other parents/guardians/caregivers in group sessions, to use skills and strategies to address behaviors impacting the patient’s mental or physical health diagnosis. The parents/caregivers learn how to structure the environment to actively provide for and reinforce desired behaviors, reduce the negative impacts of the patient’s diagnosis on their daily life, and develop highly structured technical skills to better manage specific behaviors. These skills and strategies help to support compliance with the identified patient’s treatment and the clinical plan of care.

The parents/caregivers of a 7-year-old male patient with ADHD and disruptive behavior is referred for group caregiver behavior management training to learn strategies and techniques to improve monitoring and management of patient’s behaviors to facilitate positive behavior changes and improve overall symptom management and functioning.

Description of work

Review patient records, including those from the patient’s physician and other team members, and review results of any prior diagnostic services. The physician or qualified health care professional initiates multiple-family group behavior treatment guidance/training intervention for parents/caregivers, and begins training the parents/caregivers on new skills to help reduce challenging behaviors in their child (e.g., aggression, defiance) that are resulting from the identified patient’s diagnosis of ADHD with ODD. Parents/caregivers are taught how to set realistic and age-appropriate expectations for children’s behavior; praise positive behaviors that parents want to encourage (e.g., sharing); provide positive attention (e.g., special, one-on-one play time); ignore minor misbehaviors (e.g., throwing blocks in play); and implement time-out from attention for negative child behaviors.  Training is provided via verbal instruction, video, and live demonstrations where parents/caregivers role-play and use skills they’ve been taught. The physician or QHP, and the other parents in the group session then provide feedback. The physician or QHP documentation in the medical record for each patient includes description of patient’s status, description of the parents/caregivers status, in addition to services provided and progress toward and/or modification of treatment goals based on patient and/or parents/caregivers progress or other confounding factors that arise.

• Report CPT^® code 96202 for the 60 minutes of the service.
• If the group was for 90 minutes then you would report CPT^® code 96202 for the first 60 minutes of the service two units of 96203 to indicate that the it took 30 additional minutes to complete the service.

• Do not report 96202 for less than 31 minutes.
• Use 96203 in conjunction with 96202.
• Do not report 96202/96203 for behavior management services to the patient and the parents/caregivers during the same session.
• Do not report CBMT in conjunction with Adaptive Behavior services (97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T).

Psychologists should document the start and stop times or total face-to-face time with the patient because CBMT codes are time-based services.

CBMT services are typically provided over a series of 8 to 12 closed group sessions. Each session typically lasting between 60–90 minutes.

Code 96202 is used to report the 60 minutes of service, while 96203 is used to report each additional 15-minute increment of time required to complete the overall service. Because these services are time-based, the “CPT Time Rule” does apply, which means that a unit of the base or add-on code can be reported on the claim form once half of the total time stated in the code descriptor has been passed (e.g. for a 60 minute code, at least 31 minutes of service must be provided to report the code on the claim form).

CBMT services are reported once per identified patient represented in the room for the total duration of the session. If the patient has two or more parents/caregivers participating in the session, the physician or QHP would only report the service on the claim form as if the identified patient had a single representative participating in the service.

CPT coding guidance states “Do not report 96202 for behavior management services to the patient and the parent(s)/guardian(s)/caregiver(s) during the same session.” If the patient and the parents/guardians/caregivers are seen together, during the same session, then the appropriate service to report would depend on the identified patient’s primary diagnosis.

• For an identified patient with a primary mental health diagnosis, it may be appropriate to report code 90847 for family psychotherapy, with patient present.
• For an identified patient with a primary physical health diagnosis, it may be appropriate to report health behavior family intervention services (codes 96167/96168).

It is common for the identified patient to attend group sessions of their own, and sometimes the patient’s group service runs concurrently with the parent/caregiver services; therefore, CBMT (96202/96203) will frequently be reported on the same date of service as group psychotherapy (code 90853) or group health behavior intervention (codes 96164, 96165) services.

As previously stated, CBMT services aim to teach specific behavioral management/modification procedures, strategies, and interventions that will improve the identified patient’s functioning as well as allow them to better manage the identified patient’s presenting mental or physical health diagnosis.

For educational services rendered to patients in a group setting [e.g., prenatal, obesity, or diabetic instructions], use code 99078.

For education provided as genetic counseling services, use 96040. For education to a group regarding genetic risks, see 98961, 98962.

Counseling risk factor reduction and behavior change intervention codes (99401, 99402, 99403, 99404, 99406, 99407, 99408, 99409, 99411, 99412) are included in CBMT services and may not be separately reported on the same date of service by the same provider provided by a physician or other QHP to patients.

For educational and training services that use a standardized curriculum and are provided to patients with an established illness/disease, report 98961, 98962. For patients without symptoms or established disease, see 99401, 99402, 99403, 99404, 99406, 99407, 99408, 99409, 99411, 99412.

Unfortunately, under Medicare, it is not typical to reimburse for services that aren’t rendered directly to the patient. In the 2023 Medicare Physician Fee Schedule Final Rule, the Centers for Medicare and Medicaid Services (CMS) said that for Calendar Year 2023, they will not reimburse for CBMT services. APA strongly believes that CBMT is a distinct and reimbursable service, and we will continue to work towards making this a reimbursable service in Medicare. CBMT services are the “gold standard” when it comes to treatment of children, adolescents, and adults as described above.

We also believe that Medicaid and commercial payers will see the numerous benefits to offering coverage for this service, as outlined in APA’s Payers Guide to Implementing Caregiver Behavior Management Training CPT^® Codes. APA recommends that, in order to reduce the risk of your claim(s) being denied for reporting noncovered/noncontracted codes, you should check each commercial payer policy, as well as the list of codes included in your contract with each payer, to determine which codes are covered/reimbursed. We also encourage you to work with your payers to ensure psychologists will be reimbursed for these efficient, economical and effective services.

While CBMT services are not yet covered by Medicare, many commercial payers utilize the CMS-1500 form for submitting claims, therefore, we are providing examples below of how to report these services.

CPT code 96202 is used to report the first 60 minutes of the CBMT service. The CPT Time Rule does apply here, so as long as the service last at least 31 minutes, one unit of the code can be reported. CPT code 96203 is used to report each additional increment of 15 minutes time it took to complete the CBMT services.

This illustration, using the CMS-1500 form, shows how to report CBMT services that were provided for a total of 90 minutes.