2025 CPT code 97151
(Active) Effective Date: N/A Medicine - Adaptive Behavior Services Feed
Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan.
Modifiers may be applicable in certain situations to clarify the services provided. For example, modifier 24 may be used to indicate an unrelated evaluation and management service during a postoperative period.
Medical necessity for this code must be supported by documentation demonstrating the patient's functional impairments due to deficient adaptive or maladaptive behaviors, the need for a comprehensive assessment to identify these behaviors, and the development of a treatment plan to address the identified issues.The documentation should demonstrate how the assessment will benefit the patient's overall health and well-being.
The physician or other qualified healthcare professional is responsible for administering and interpreting the assessment, developing the treatment plan, and communicating the findings and recommendations to the patient's guardian(s)/caregiver(s).They must oversee the entire process, including any supporting assessments performed by technicians.
In simple words: This code covers the time a doctor or other qualified healthcare professional spends assessing a patient's behavior. It includes time spent with the patient and family, as well as time spent reviewing records, analyzing test results, and creating a treatment plan.The assessment helps identify behaviors that are causing problems and develops a plan to improve them.
This code represents a behavior identification assessment conducted by a physician or other qualified healthcare professional.It includes both face-to-face time spent with the patient and/or their guardian(s)/caregiver(s) administering assessments, discussing findings, and making recommendations, as well as non-face-to-face time spent analyzing past data, scoring and interpreting the assessment, and preparing the report and treatment plan.The assessment may involve analyzing pertinent past data (including medical diagnosis), taking a detailed behavioral history, observing the patient, administering standardized and/or non-standardized instruments and procedures, conducting a functional behavior assessment and/or functional analysis, and interviewing the guardian/caregiver.The goal is to identify and describe deficient adaptive behaviors, maladaptive behaviors, and other impaired functioning related to these behaviors.Each unit of this code represents 15 minutes of the physician's or other qualified healthcare professional's time.
Example 1: A child with autism spectrum disorder undergoes a comprehensive behavioral assessment by a psychologist to identify social, communication, and behavioral challenges, leading to the development of an individualized treatment plan., A teenager with oppositional defiant disorder is assessed by a psychiatrist to pinpoint triggers for aggressive behaviors and develop strategies for managing anger and improving family interactions., An adult with traumatic brain injury is evaluated by a neuropsychologist to assess cognitive and behavioral deficits and create a rehabilitation plan to improve daily functioning.
Documentation should include details of the assessment procedures used, patient history, observation notes, results of standardized and non-standardized instruments, interpretation of findings, diagnosis, recommendations, and the developed treatment plan. All face-to-face and non-face-to-face time spent by the physician or other qualified healthcare professional should be documented.
- Specialties:Developmental-Behavioral Pediatrics, Psychiatry, Psychology, Neuropsychology, and other specialties involved in the assessment and treatment of behavioral health conditions.
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, and other settings where behavioral health assessments are conducted.