Beginning Jan. 1, psychologists will need to use new CPT® codes when billing third-party payers for health and behavior (H&B) services, according to the proposed rule on the 2020 Medicare Physician Fee Schedule from the Centers for Medicare and Medicaid Services (CMS).
The name of the code family is also changing from Health & Behavior Assessment/Intervention to Health Behavior Assessment and Intervention (HBAI) to reflect greater focus on psychological and/or psychosocial factors in health and the increased role of these services in interdisciplinary care, particularly in primary and specialty care settings.
The proposed rule calls for the existing CPT codes for reporting H&B services (96150, 96151, 96152, 96153, 96154 and 96155) to be deleted and replaced with these changes to the code set:
- Health behavior assessment services. Assessment and re-assessment services will be reported using a single, untimed code: 96156, which will replace codes 96150 and 96151.
○ Example: A 65-year-old male with osteoarthritis, chronic back pain and medication-related somnolence is referred for health behavior assessment to determine the psychological factors requiring intervention as part of the patient's overall treatment plan.
- Health behavior intervention services. There will be a new coding structure with updated units of time for reporting intervention services. Psychologists must now use a stand-alone base code to report the first 30 minutes of performing the primary intervention service, and a 15-minute add-on code — which can be billed multiple times — to report beyond the first 30 minutes required to complete the intervention service.
The revised intervention codes are as follows (+ Indicates an add-on code that can only be reported with the corresponding base code):
- 96158 & +96159: The intervention service provided to an individual to modify the psychological, behavioral, cognitive and social factors affecting the patient's physical health and well-being.
Example: A 55-year-old female with heart disease, migraines and hypertension is referred for health behavior services to improve patient treatment compliance and engagement in self-management.
- 96164 & +96165: The intervention service provided to a group of two or more patients.
- Example: A 26-year-old obese female post-bariatric surgery with poor adherence to treatment regimens and multiple medical complications is referred for group health behavior intervention.
- 96167 & +96168: The intervention service provided to a family with the patient present.
- Example: A 36-year-old married female diagnosed with breast cancer and who is undergoing aggressive chemotherapy and radiation therapy with poor adherence to treatment regimens and multiple medical complications is referred for family intervention.
- 96170 & +96171: The intervention service provided to a family without the patient present.
- Example: The family of a 9-year-old boy diagnosed with Type I diabetes is referred for intervention because of the patient's continuing refusal to self-inject his insulin and to test his own glucose levels. Note: Services offered when the patient is not present are not typically covered by Medicare.
The new set of codes (PDF, 70KB) can be found on APA Services Inc.’s website in the “Reimbursement” section. In addition to the coding structure changes, APA successfully advocated for increases to the relative value units for these codes. A list of the proposed 2020 Work Relative Value Units (PDF, 74KB) is also available on APA Services. CMS will reveal the final values in November (values take effect Jan. 1, 2020).
To compare the 2019 H&B codes and the new HBAI codes for 2020, visit the Crosswalk for 2020 Health Behavior Assessment and Intervention CPT® Codes (PDF, 107KB) page.
Article edited Oct. 28, 2019