2025 CPT code 96167
(Active) Effective Date: N/A Medicine Services and Procedures - Health Behavior Assessment and Intervention Procedures Feed
Health behavior intervention, family (with the patient present), face-to-face; initial 30 minutes.
Modifiers may be applicable in specific circumstances, such as when distinct procedural services are provided. Modifier 59 may be used to indicate that the health behavior intervention was distinct or independent from other services provided on the same day.
Medical necessity must be established by linking the intervention to the patient's underlying physical health condition and demonstrating how the psychological and/or psychosocial factors are complicating the medical condition or treatment. The documentation should support the need for family involvement to address these factors and improve the patient's overall health outcomes.
A qualified healthcare professional, often a psychologist, leads the intervention.They assess the patient's responses to their illness, coping mechanisms, motivation, and adherence to medical treatment. The provider uses clinical interviews, observation, and clinical decision-making to develop strategies for improving the patient's health behaviors and family dynamics related to their condition.Active patient and family engagement is key.
In simple words: The doctor speaks with you and your family for about half an hour to help you understand and cope with factors that are making your physical health condition more difficult.This session focuses on how your behaviors and interactions with your family can be adjusted to improve your overall health.
This code refers to a health behavior intervention provided to a family, with the patient present, conducted face-to-face for an initial 30 minutes.The intervention focuses on addressing psychological, behavioral, emotional, cognitive, and interpersonal factors impacting the patient's physical health. The aim is to improve the patient's health and well-being by employing psychological and/or psychosocial interventions to alleviate specific disease-related problems.
Example 1: A patient with poorly controlled diabetes struggles with dietary adherence and family members unknowingly enable unhealthy eating habits. This intervention addresses family dynamics and promotes healthier lifestyle choices., A patient undergoing chemotherapy experiences significant emotional distress and family conflict, impacting treatment adherence.This intervention provides coping strategies and improves family support during treatment., A patient with chronic pain exhibits maladaptive pain behaviors and family members reinforce these behaviors. The intervention educates the family about pain management and encourages adaptive behaviors.
Documentation should include the patient's primary physical diagnosis, details of the health-focused clinical interview, observed behaviors, clinical decision-making process, interventions implemented, family involvement, and the time spent in the face-to-face session. The focus of the intervention should be clearly documented as related to the patient's physical health, not primarily mental health.
** Do not use this code for stand-alone family therapy addressing primarily mental health conditions.Ensure documentation clearly supports the connection between the intervention, the patient's physical health, and the medical necessity of family involvement. Refer to iFrameAI for the most up-to-date information and specific payer guidelines.
- Specialties:Psychology, Behavioral Health, and other specialties managing patients with physical health conditions impacted by psychological and psychosocial factors.
- Place of Service:Outpatient clinics, hospitals, and other settings where face-to-face health behavior interventions can be delivered.