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2025 CPT code 96165

Health behavior intervention, group (2 or more patients), face-to-face; each additional 15 minutes (List separately in addition to code for primary service)

This code is an add-on code and must be used in addition to the primary procedure code 96164. It is time-based and requires documentation of the total time spent providing the service. The focus of the service must be on the psychological and psychosocial factors related to a physical health condition. This is not for preventive medicine counseling or risk factor reduction.

Modifiers may be applicable. Refer to current CPT guidelines for appropriate modifier usage.

Medical necessity is established by the presence of a physical health condition significantly impacted by psychological and/or psychosocial factors. The documentation must support how the intervention aims to improve the patient's health outcomes and overall well-being related to the underlying physical condition.

In simple words: This code covers additional time spent in group therapy sessions (2 or more patients) focused on managing the mental and emotional challenges related to physical health problems.These sessions aim to improve patients' coping skills and overall well-being by addressing factors like stress, motivation, and adherence to treatment plans.

This code describes the provision of health behavior intervention services to a group of two or more patients, conducted face-to-face.It is used for each additional 15 minutes beyond the initial 30 minutes (represented by code 96164). The service focuses on addressing psychological, behavioral, emotional, cognitive, and interpersonal factors impacting the management of physical health problems.It includes promoting functional improvement, minimizing psychosocial barriers to recovery, and improving coping mechanisms related to medical conditions. The service requires active patient/family engagement.

Example 1: A group of patients with diabetes meet with a psychologist to discuss stress management techniques for better blood sugar control. The session extends beyond the initial 30 minutes covered by 96164, requiring the use of 96165 for the additional time., Patients recovering from heart surgery participate in a group session focused on adjusting to lifestyle changes and emotional support. The session runs longer than the initial 30 minutes, and 96165 is used for the extra time., Cancer patients and their families participate in a support group led by a social worker to address coping strategies, anxiety, and communication challenges.96165 is reported for the time beyond the first 30 minutes of the session.

Documentation should support the medical necessity of the service by demonstrating how the psychological and/or psychosocial factors are impacting the patient's physical health. The total time spent providing the service must be clearly documented. The content and focus of the intervention should also be documented, including patient/family engagement.

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