2025 CPT code 96171
(Active) Effective Date: N/A Revision Date: N/A Medicine - Health Behavior Assessment and Intervention Procedures Medicine Services and Procedures Feed
Health behavior intervention, family (without patient present); each additional 15 minutes.
Modifiers may be applicable based on the circumstances of service.Consult the CPT manual and payer guidelines for specific modifier rules. For instance, modifier 59 might be necessary if the service is distinctly separate from other services on the same day.
Medical necessity is established by demonstrating a clear link between the family dynamics and the patient's ability to manage their underlying medical condition.Documentation should illustrate how unresolved family issues are significantly impacting the patient's treatment adherence, recovery, or overall health.
The clinical responsibility lies with a psychologist or other qualified healthcare professional who addresses family-related barriers to a patient's self-management of chronic disease. The provider facilitates communication, offers coping strategies, and educates family members on how to support the patient’s health management and recovery.
- Medicine Services and Procedures
- Medicine Services and Procedures > Health Behavior Assessment and Intervention Procedures
In simple words: This code covers extra time spent talking with a patient's family about how to help the patient manage their health problems.The patient is not at this meeting. The doctor or therapist gives the family tips and strategies to improve the patient's health, addressing things like family stress or other issues affecting the patient's condition.
This CPT code, 96171, represents each additional 15 minutes of face-to-face health behavior intervention (HBI) with a patient's family when the patient is not present.The intervention focuses on addressing family-related barriers to the patient's self-management of chronic diseases.It involves discussing interventions and strategies to help the patient overcome factors hindering recovery, such as intellectual, cultural, psychophysiological, and emotional issues. The provider uses cognitive and behavioral approaches to encourage changes in family dynamics and behaviors that negatively impact the patient's coping skills and disease management.This code is reported in addition to the initial 30-minute code (96170).
Example 1: A patient with poorly controlled diabetes is referred for health behavior intervention due to family conflict hindering adherence to treatment.The psychologist meets with the family (without the patient) for 45 minutes to address communication issues and create strategies for improved patient support.Codes 96170 and 96171 would be used., A patient with chronic obstructive pulmonary disease (COPD) has difficulties managing their medication regimen due to family dynamics. The psychologist conducts a 75-minute session (96170 plus two units of 96171) with the family (patient absent) to improve family communication and adherence to medication., A patient recovering from a stroke exhibits significant emotional and behavioral challenges exacerbated by family stressors. A 60-minute session (96170 and 96171) is conducted with the family (without the patient) focusing on coping mechanisms and strategies for emotional support during rehabilitation.
Detailed notes documenting the session's content, including specific family dynamics addressed, intervention strategies discussed, and goals set.The diagnosis must be clearly documented, and the medical necessity of the family intervention should be established, linking the session to the patient's physical health problem.
** This code is an add-on code and must be reported in addition to the primary service code 96170.Each additional 15 minutes of family session (without the patient present) should be reported separately.The family session should focus on resolving barriers to the patient’s physical health management and recovery, not solely on mental health issues.
- Revenue Code: M5D (SPECIALIST - OTHER)
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Psychology, Social Work, Psychiatry (in limited contexts where psychosocial factors significantly affect a primary physical condition).
- Place of Service:Office, Outpatient Hospital, Other Place of Service (depending on where family sessions are held).