2025 CPT code 97152
(Active) Effective Date: N/A Revision Date: N/A Assessment - Adaptive Behavior Services Medicine Services and Procedures Feed
Behavior identification supporting assessment; administered by one technician under physician or qualified healthcare professional direction; face-to-face with patient; each 15 minutes.
Modifiers may apply based on the specific circumstances of the assessment.Consult the CPT® manual for guidance on appropriate modifier use.
Medical necessity is established when the patient presents with behavioral challenges that impair their adaptive functioning and require a comprehensive assessment for treatment planning.The assessment should be deemed necessary by a physician or qualified professional based on the patient’s clinical presentation and history.
A technician, under the direction of a physician or other qualified healthcare professional, conducts a face-to-face behavioral assessment. The supervising physician reviews findings and creates a treatment plan.
In simple words: This code describes when a trained technician, working with a doctor or other qualified professional, spends 15 minutes directly observing and assessing a patient's behavior.The technician interacts with the patient, looking for helpful and harmful behaviors, and reports their findings to the doctor. This may happen multiple times during the same visit.
CPT code 97152 represents a behavior identification supporting assessment conducted by a single technician under the supervision of a physician or other qualified healthcare professional.The assessment involves direct, face-to-face interaction with the patient for a duration of 15 minutes.This code may be reported multiple times in a single day, reflecting the total 15-minute increments of face-to-face interaction. The physician or qualified professional interprets the results, potentially incorporating functional behavior assessments, functional analyses, and structured observations using standardized or non-standardized instruments.The assessment aims to determine the levels of adaptive and maladaptive behaviors.
Example 1: A child with autism spectrum disorder undergoes a 97152 assessment to evaluate their adaptive and maladaptive behaviors during play therapy.The technician, under the supervision of a psychiatrist, observes the child's interactions, records data, and reports findings to the psychiatrist for treatment plan development., An adult with a traumatic brain injury receives a 97152 assessment to evaluate their daily living skills and social interactions. The technician observes the adult completing tasks and interacting in social settings. This data is used by a neuropsychologist to create personalized rehabilitation goals., An elderly patient with dementia displays disruptive behaviors in a long-term care facility. A technician performs a 97152 assessment observing the patient's interaction with staff and other residents, using standardized and non-standardized instruments to analyze behavior patterns and identify triggers for further action by the geriatric psychiatrist.
Detailed documentation is crucial, including the time in and time out of each 15-minute interval of face-to-face interaction with the technician, the names of staff and caregivers present, place of service, assessment report, specific assessments administered, and the renderer’s signature.Detailed notes on the patient's behavior, specific behaviors observed, and the assessment tools used should be included in the medical record.
** The total time spent on assessment should be reported in 15-minute increments.Only one technician's time is counted if multiple technicians are present. The physician's or other qualified professional's time is reported separately with code 97151.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier is typically not applicable to this code as the assessment is considered a comprehensive service, not separable into professional and technical components.
- Specialties:Psychiatry, Psychology, Neurology, Occupational Therapy, Behavioral Health
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Skilled Nursing Facility,Other Place of Service (depending on the patient’s setting)