The CPT Codes associated with behavioral health are changing soon. Here’s what you need to know:
The Centers for Medicare and Medicaid Services (CMS) has proposed new changes to the existing CPT codes in the form of the 2020 Health Behavior Assessment and Intervention CPT Codes. The changes will come into effect on January 1st, 2020. These new sets of codes will will reflect greater attention on psychological and/or psycho-social factors and help increase the function of health and behavior services in interdisciplinary care.The changes include the deletion and replacement of some existing codes with the new code set.
The Revised CPT Codes and Descriptors
|2019 CPT Code No.||2019 CPT Descriptor||2020 CPT Code No.||2020 CPT Descriptor|
|96150||Initial Assessment; health and actions assessment and re-assessment – includes health-focused clinical interviews, behavioral observations, health-focused questionnaires, psycho-physiological monitoring. Each 15 minutes face-to-face with patient.||96156*||Health behavior assessment or reassessment – includes health-focused clinical interviews, behavioral observations, and clinical decision making|
|96151||Re-assessment; health and behavior assessment and re-assessment – includes health-focused clinical interviews, behavioral observations, health-focused questionnaires, psycho-physiological monitoring. Each 15 minutes; face-to-face with patient.|
|Individual Intervention Services|
|96152||Health and behavior intervention; individual; each 15 minutes; face-to-face||96158||Health behavior intervention; individual; initial 30 minutes; face-to-face|
|96159*||Health behavior intervention; individual; each additional 15 minutes; face-to-face|
|Group Intervention Services|
|96153||Health and behavior intervention; group (two or more patients); each 15 minutes; face-to-face||96164||Health and behavior intervention; group (two or more patients); initial 30 minutes; face-to-face|
|96165*||Health and behavior intervention; group (two or more patients); additional 15 minutes; face-to-face|
|Family Intervention with Patient Present|
|96154||Health and behavior intervention; family (with patient present); each 15 minutes; face-to-face||96167||Health and behavior intervention; family (with patient present); initial 30 minutes; face-to-face|
|96168*||Health and behavior intervention; family (with patient present); each additional 30 minutes; face-to-face|
|Family Intervention without Patient Present|
|96155||Health and behavior intervention; family (without patient present); each 15 minutes; face-to-face||96170||Health and behavior intervention; family (without patient present); initial 30 minutes; face-to-face|
|96171*||Health and behavior intervention; family (without patient present); each additional 15 minutes; face-to-face|
The 2020 Health Behavior Assessment and Intervention Services
The proposed health behavior Assessment and intervention replaces the previous code family name “Health & Behavior Assessment/Intervention”. According to the American Psychological Association, the primary objective of HBAI services will be to identify and address factors of importance affecting the psychological, behavioral, cognitive, emotional, and interpersonal health of patients. It will achieve this through assessment, treatment, and management of patient physical health problems.
The new codes maintain the understanding of assessment services as evaluation or reevaluation measures of patient responses to disease or injury. This includes their outlook, motivation, coping strategies, and adherence to medication. However, assessment services will no longer be time-based. Instead, the new codes propose the understanding of assessment as an event-based service, primarily through health-oriented clinical interviews, observations, and clinical decision-making. These are contained in the new code 96156, which replaces codes 96150 and 96151.
Health behavior intervention services based on the new CPT codes will focus on the promotion of functional improvement, management of medical conditions, minimization of psychological and psychosocial impediments to recovery, and improvement of medical conditions. These codes generally guide the participation of patients (individuals and groups) and families in health interventions. As such:
- The previous CPT code 96152 has been split into two codes, 96158 in conjunction with the new 96159. Here, the intervention service is offered to individuals to improve psychological, behavioral, social, and cognitive factors affecting their health and wellbeing.
- CPT 96153 of the previous health and behavior group intervention has also been split to include codes 96164 in conjunction with the new 96165 addon. The new CPT code 96164 is reported for the initial 30 minutes of group intervention services offered to two or more patients. Code 96165 is reported in conjunction with the new code for each additional 15 minutes required to complete the service.
- The 2019 CPT code 96154 will be covered by codes 96167 and 96168, which report face-to-face health behavior interventions involving families. The add-on code 96167 is only reported in conjunction with code 96167.
- Finally, codes 96170 and 96171 will be added to replace the previous code 96155 to report face-to-face health behavior interventions involving families. Unlike the individual and group health behavior interventions, reporting these codes will not require the presence of the patient. However, AMA indicates that these services are largely available where the patient is not normally covered by Medicare.
Implications of CPT Code Changes
The promulgation of new CPT code changes is expected to help physicians and patients obtain meaningful and asynchronous connections beyond the face-to-face setting. This makes it easier for patients to make the most of health and behavioral care settings, especially where time and space barriers are likely barriers to the delivery of that care. Reporting the new CPT codes will largely involve online digital evaluation services designed to make the connection between caregiver and care receivers more patient-initiated. Other than these five sets of codes, CMS is expected to approve an addition 242 new CPT codes in 2020 as it considers even broader assessment and intervention measures for physicians, medical societies, and the health care community at large. Among those codes, two will be aimed at enabling patients to participate in their care away from health facilities.
Other than improving health delivery for both patients and healthcare providers, the code changes also work towards providing reliable medical billing for payment companies through better reporting procedures and services. The new codes cater to patients with difficulty paying for their medical care for financial reasons or proximity. The bottom line is that if you are currently billing codes 91650 through 90655, those codes will no longer be valid codes, and will need to be replaced with codes listed in our crosswalk table above.