2025 CPT code 96170
(Active) Effective Date: N/A Revision Date: N/A Medicine - Health Behavior Assessment and Intervention Procedures Medicine Services and Procedures Feed
Health behavior intervention with family (patient absent); initial 30 minutes face-to-face.
Modifiers may apply depending on the circumstances. Consult the CPT manual and local payer guidelines for applicable modifiers.
Medical necessity for this code is established when there are significant family-related barriers to a patient's self-management of a chronic illness or when family dynamics negatively affect the patient's health and treatment adherence.The intervention should be medically necessary to improve the patient's health outcomes and should be tailored to the specific challenges faced by the patient and their family.
The clinical responsibility lies with a psychologist or other qualified healthcare professional who specializes in health behavior interventions.The provider's role includes conducting a thorough assessment of family dynamics and their impact on the patient's health, developing and implementing intervention strategies tailored to the family's needs, and monitoring the effectiveness of interventions.
In simple words: This code covers a 30-minute meeting with a patient's family (without the patient present) to help improve the patient's health.A healthcare provider talks to the family about ways to change behaviors or family interactions that negatively affect the patient's health or ability to follow medical advice. They work together to find ways to improve the patient's overall well-being.
This CPT code, 96170, represents the initial 30 minutes of face-to-face health behavior intervention with a patient's family, conducted without the patient's presence.The intervention focuses on addressing family-related barriers to the patient's self-management of chronic diseases. This includes identifying and addressing psychological, behavioral, emotional, cognitive, and interpersonal factors impacting the patient's health and adherence to treatment.The provider utilizes various strategies, including counseling and behavioral techniques, to encourage changes in family dynamics and behaviors that hinder the patient's recovery or compliance with medical recommendations.Additional time beyond the initial 30 minutes is reported using code 96171.
Example 1: A patient with newly diagnosed type 2 diabetes is struggling to manage their diet and exercise routine.Their family is resistant to lifestyle changes, leading to poor patient compliance.A psychologist meets with the family (without the patient) to address these issues and facilitate better support from family members., A patient recovering from a stroke is experiencing emotional distress and difficulty adapting to their physical limitations.The family is overwhelmed and unsure how best to provide support.A health behavior intervention session with the family is used to improve communication and coordination of care., A child diagnosed with cystic fibrosis requires daily medication and frequent respiratory treatments. The family is struggling with the demanding treatment regimen and its impact on the family's life and structure. A therapist meets with the family to improve their coping mechanisms and increase their adherence to treatment.
Detailed documentation should include the patient's diagnosis, the family's involvement, the specific behavioral issues addressed, intervention strategies utilized, family members' engagement, and the overall goals and outcomes of the session.Progress notes should document the session's duration, participants, key discussions, treatment plan elements, and family's understanding and commitment.
** This code is specifically for family sessions conducted without the patient present.If the patient is present, different CPT codes apply.Always ensure that the documentation clearly supports the medical necessity of the service and the time spent.
- Revenue Code: M5D (SPECIALIST - OTHER)
- RVU: This information is not provided in the source.Consult the relevant fee schedule for current RVU values.
- Global Days: Not applicable. This is not a surgical procedure.
- Payment Status: Active
- Modifier TC rule: Not applicable. This is not a procedure with a technical component.
- Fee Schedule: Fee schedule information is not available from the sources.Consult the relevant fee schedule for historical and current payment information.
- Specialties:Psychology, Social Work, Family Therapy
- Place of Service:Office, Outpatient Hospital, Other Place of Service (depending on the provider's location and setting)