The use of these CPT® codes requires a physical health diagnosis. Typically, health and behavior assessment and intervention services address an assortment of physical health issues — including patient adherence to medical treatment, symptom management, health-promoting behaviors, health-related risk-taking behaviors and overall adjustment to physical illness.
Yes, being diagnosed with a mental health disorder does not preclude a patient from being eligible to receive health and behavior services to address a diagnosed physical health problem.apy services less than 26 minutes.
Medicare reimburses for five out of the six codes, with the exception of 96155 (Health and behavior intervention, each 15 minutes, face-to-face, family without the patient present). Some private health insurance plans have begun to pay for these codes as well. Private insurance plans may have payment policies that are more or less restrictive than under Medicare. Psychologists should check with the private insurer about a plan's payment policies regarding these codes.
No, only an ICD-10-CM physical diagnosis code should be used in connection with these services. A physical diagnosis code applies since health and behavior assessment and intervention services focus on patients whose primary diagnosis is a physical health problem.
No, the Outpatient Mental Health Treatment Limitation applies only to services provided to outpatients with a mental, psychoneurotic or personality disorder. Health and behavior assessment and intervention services provided to outpatients are reimbursed at 80 percent.
For additional information, contact our Government Relations Department at (202) 336-5889.