2025 CPT code 96164
(Active) Effective Date: N/A Medicine - Health Behavior Assessment and Intervention Procedures Feed
Health behavior intervention, group (2 or more patients), face-to-face; initial 30 minutes.
Modifiers may be applicable.
Medical necessity for this code requires a documented physical health condition and associated psychological or psychosocial factors impacting the patient's ability to manage their condition or treatment plan.
The provider assesses and addresses barriers impacting the self-management of chronic diseases in patients. Strategies are offered to overcome intellectual, cultural, psychophysiological, and emotional factors hindering recovery. Improved coping skills are taught and guidance provided to remove psychological obstacles to managing chronic medical illnesses.
In simple words: The provider counsels and provides strategies to two or more patients for managing factors that affect their physical health.This session lasts for 30 minutes.
This code represents the first 30 minutes of face-to-face health behavior intervention (HBI) services provided to a group of two or more patients. The provider, typically a psychologist, offers counseling and strategies to manage cognitive, emotional, social, and cultural factors influencing the patients' physical health problems.
Example 1: A group of patients with diabetes attends a session to learn coping mechanisms for managing their diet and medication adherence., Patients with chronic pain participate in a group session focused on strategies for managing pain flare-ups and improving daily functioning., Cancer patients in a support group receive guidance on managing emotional distress and improving quality of life during treatment.
Documentation should include the patient's primary physical diagnosis, the psychological and/or psychosocial factors complicating the medical condition, the content of the intervention provided, the total time spent with the group, and the patients present during the session.
- Specialties:Psychology, Behavioral Health, Primary Care
- Place of Service:Office, Outpatient Hospital, Other Place of Service