2025 CPT code 97157
(Active) Effective Date: N/A Medicine - Adaptive Behavior Treatment Procedures Feed
Multiple-family group adaptive behavior treatment guidance, without the patient present.
Modifier 59 may be used to indicate a distinct procedural service. Modifier 95 may be applicable for telehealth services.
Medical necessity should be established by documenting the patients' diagnoses, adaptive behavior deficits, and the rationale for family guidance.
The provider meets face-to-face with guardians or caregivers of multiple patients. They discuss problem behaviors or skill deficits, explain the treatment protocol, and train the caregivers to implement it.This service aims to reduce maladaptive behaviors and improve adaptive skills.
In simple words: The provider discusses multiple patients’ adaptive behavior treatment face-to-face with a group of guardians or caregivers, without the patients present. This service is reported for each 15 minutes spent with the group.Adaptive behavior treatment helps individuals adjust to their environment and improve skills like communication, social interaction, and self-care.
Multiple-family group adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of guardians/caregivers, each 15 minutes. (Do not report 97157 if the group has more than 8 families). (Do not report 97156, 97157 in conjunction with 90785-90899, 96105-96171)
Example 1: A physician leads a 1-hour session with five families of children with autism, teaching them strategies to manage challenging behaviors at home. This would be reported as four units of 97157., A psychologist conducts a 30-minute group session with parents of children with developmental delays, providing guidance on communication techniques. This would be reported as two units of 97157., A therapist facilitates a 45-minute training session for caregivers of individuals with intellectual disabilities, focusing on adaptive living skills. This would be reported as three units of 97157.
Documentation should include the number of families present, the total duration of the session, the content of the guidance provided, and the goals of the treatment plan.
- Specialties:Developmental Pediatrics, Psychology, Applied Behavior Analysis
- Place of Service:Office