2025 CPT code 96158
(Active) Effective Date: N/A Medicine - Health Behavior Assessment and Intervention Procedures Feed
Health behavior intervention, individual, face-to-face; initial 30 minutes.
Modifiers such as 59, 76, 77, 79, and others may be applicable.Refer to current CPT guidelines for appropriate modifier usage.
Medical necessity for health behavior intervention must be established by demonstrating that the patient's physical health problem is significantly impacted by psychological or psychosocial factors.The documentation should clearly link the interventions provided to the patient's physical health needs.
The provider, typically a psychologist or other qualified healthcare professional, assesses the patient's responses to their illness, their coping mechanisms, motivation, and adherence to medical treatment.They develop and implement interventions to improve the patient's health and well-being by addressing psychological and psychosocial barriers to recovery.
In simple words: The provider counsels the patient one-on-one for 30 minutes, offering strategies to manage thoughts, feelings, and social factors affecting their physical health.This helps patients cope with and better manage their physical illness.
This code represents the initial 30 minutes of face-to-face health behavior intervention provided to an individual patient.The intervention focuses on psychological and/or psychosocial factors impacting the management of a patient's physical health problems. It includes counseling and strategies to address cognitive, emotional, social, and cultural factors that may complicate medical conditions and treatments.
Example 1: A patient with diabetes struggles with adherence to their diet and medication regimen. The provider uses health behavior intervention to address the emotional and behavioral factors contributing to the non-adherence., A patient with chronic pain experiences depression and anxiety, which exacerbates their pain. The provider implements health behavior intervention to teach coping mechanisms and improve emotional well-being., A patient recently diagnosed with cancer has difficulty adjusting to the diagnosis and treatment plan. Health behavior intervention is used to provide emotional support and assist the patient in coping with the challenges of their illness.
Documentation should include the primary physical diagnosis, details of the health behavior assessment, the specific interventions used, the patient's response to the interventions, and time spent providing the service.
** This code is intended for use with patients whose primary issue is a physical illness and who would benefit from interventions addressing psychological and psychosocial factors affecting their health. It should not be used for patients requiring primary psychiatric care.
- Specialties:Psychology, primary care, and other medical specialties dealing with chronic physical illnesses.
- Place of Service:Office, Outpatient Hospital, and other places of service where face-to-face services are provided.