2025 CPT code 96168
(Active) Effective Date: N/A Medicine - Health Behavior Assessment and Intervention Procedures Medicine Feed
Health behavior intervention, family (with the patient present), face-to-face; each additional 15 minutes (List separately in addition to code for primary service)
Appropriate modifiers may be applicable based on specific circumstances. Refer to current CPT guidelines for modifier usage.
Medical necessity for this code is established by the presence of a diagnosed physical health condition negatively impacted by psychosocial and family dynamic factors. Documentation should clearly link the family intervention to the patient's physical health management and demonstrate the need for the additional 15 minutes of counseling beyond the initial 30 minutes covered by 96167.
The provider, typically a psychologist to whom the patient has been referred by the primary care physician, addresses family–related barriers to self–management of the patient’s chronic disease(s) in a face–to–face session with the patient’s family in the presence of the patient. They discuss interventions and strategies that will help the patient overcome intellectual, cultural, psychophysiological, and emotional factors that result in noncompliance or hinder recovery.
In simple words: This code covers additional time spent with a patient and their family to help them improve the patient's health by addressing psychological and social factors related to their physical condition. It involves talking about how family dynamics might be affecting the patient's ability to cope with their illness and suggesting ways to improve those dynamics.This code is used for every 15 minutes of this family session after the initial 30 minutes.
The provider interviews the patient’s family in the presence of the patient and counsels them on strategies to change family dynamics and behaviors that adversely affect the patient's physical health and coping behaviors. This code represents each additional 15 minutes of face-to-face service with the patient’s family.The provider addresses family-related barriers to self-management of the patient’s chronic disease(s) in a face-to-face session with the patient’s family in the presence of the patient. They discuss interventions and strategies that will help the patient overcome intellectual, cultural, psychophysiological, and emotional factors that result in noncompliance or hinder recovery. The provider asks questions about the patient's interactions with family members, observes the patient's behavior in response to questions or situations, and observes how the patient responds physically and emotionally to the family members and how they respond to the patient's statements and behavior. He then uses cognitive and behavioral approaches to encourage the patient and family members to change family dynamics and behaviors that adversely affect the patient's coping skills and management of the patient’s medical illness. The provider discusses next steps with the patient and the family. Report this code for each additional 15 minutes of face-to-face service with the family with the patient present.
Example 1: A patient with diabetes struggles with managing their diet due to family meal habits. The provider uses this code for the additional time spent counseling the patient and family together on making healthier choices as a family unit., A patient recovering from a stroke has difficulty with motivation for physical therapy. The provider uses this code for extra time during a session with the patient and their family present, discussing how they can support the patient's rehabilitation efforts at home., A patient with chronic pain experiences increased stress due to family conflicts. The provider uses this code for the added time spent in a family session, teaching coping mechanisms and communication skills to address the family issues contributing to the patient’s stress.
Documentation should support the established underlying diagnosis and show the total time spent in face-to-face counseling with the family and the patient present.It should detail the family dynamics discussed, the interventions provided, and the plan for future sessions, if any.
** It's crucial to accurately document the medical necessity for the additional time spent with the family, as well as the connection between family interactions and the patient's physical health.
- Specialties:Psychology, and potentially other specialties depending on the patient’s condition and referring physician.
- Place of Service:Office, Outpatient Hospital, or other applicable outpatient settings.