2025 CPT code 97156
(Active) Effective Date: N/A Medicine - Adaptive Behavior Services Feed
Family adaptive behavior treatment guidance, provided face-to-face with guardian(s)/caregiver(s), each 15 minutes.
Medical necessity for this code requires that the service is reasonable and necessary for the diagnosis or treatment of an illness or injury recognized by the medical community. The documentation must support the medical necessity of the service. It should demonstrate that the family guidance is essential for effective implementation of the patient's adaptive behavior treatment plan.
The provider discusses the patient's problem behaviors or skill deficits with the guardians or caregivers, explains the treatment protocol, and teaches them how to interact with the patient to reduce maladaptive behaviors and/or skill deficits.This service focuses on identifying potential treatment targets and training guardian(s)/caregiver(s) to implement treatment protocols designed to address deficient adaptive or maladaptive behaviors.
In simple words: The provider discusses a patient’s adaptive behavior treatment face-to-face with the guardian(s) or caregiver(s). This can happen with or without the patient present. This code is used for each 15 minutes spent in this discussion.
Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes. (Do not report 97156 in conjunction with 90785-90899, 96105-96171)
Example 1: A physician meets with the parents of a 5-year-old child diagnosed with autism spectrum disorder to discuss a treatment protocol for the child's difficulty with transitions and following instructions. The physician explains the protocol and teaches the parents how to implement it at home. This session lasts for 30 minutes, so two units of 97156 would be billed., A behavioral health specialist meets with the caregiver of an adult with Down syndrome who exhibits self-injurious behavior.The specialist explains a behavior modification plan to the caregiver and provides training on how to implement the plan consistently. The session lasts for 15 minutes, so one unit of 97156 would be billed., A therapist meets with the parents of a teenager with oppositional defiant disorder. The patient is also present at the session. The therapist discusses strategies for improving communication and reducing conflict within the family. The session lasts 45 minutes, so three units of 97156 would be billed.
Documentation should include the following: the patient's diagnosis, the specific adaptive behavior deficits or maladaptive behaviors being addressed, the treatment protocol being discussed, the guardian(s)/caregiver(s) present, the content of the discussion, and the total duration of the face-to-face encounter.
- Specialties:Developmental Pediatrics, Behavioral Health, Psychiatry, Psychology, Applied Behavior Analysis
- Place of Service:Office, Outpatient Hospital, Home, Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home