CPT® Code 96155

Code deleted, see 96170, 96171

Official Description

Health and behavior intervention, each 15 minutes, face-to-face; family (without the patient present)

Common Language Description

Health and behavior intervention services, as defined by CPT® Code 96155, are specialized therapeutic procedures aimed at enhancing health outcomes and overall well-being. These interventions are designed to address various health-related issues through cognitive, behavioral, social, and psychophysiological techniques. The primary goal is to reduce the frequency and severity of problems associated with diseases while improving the patient's quality of life. The services can be delivered by a range of qualified health care professionals, including physicians, psychologists, advanced practice nurses, and clinical social workers, all of whom possess specialized training in health and behavior interventions.

The interventions are tailored specifically to the individual patient, based on a comprehensive assessment that is separately reportable. Techniques employed during these interventions may encompass education on biopsychosocial factors that influence health, stress reduction methods such as relaxation exercises and guided imagery, and social support mechanisms, including group discussions and social skills training. Importantly, family members can be included in these intervention services, particularly when family dynamics contribute to the patient's health challenges. The provider's role may involve enhancing communication, conflict resolution, and problem-solving skills within the family unit through direct instruction and interpersonal communication exercises that can be practiced at home.

For parents of young children, the interventions may involve behavior modification strategies, such as the use of praise and rewards or distraction techniques to alleviate fear and anxiety. In the context of terminally ill patients, caregivers may receive guidance and support focused on improving communication, monitoring pain, and addressing sensitive issues related to death and dying. It is essential to report the appropriate intervention code for each 15-minute increment of service provided. For individual face-to-face encounters with the patient, CPT® Code 96152 should be used. For group face-to-face encounters, CPT® Code 96153 is applicable. When family encounters occur with the patient present, CPT® Code 96154 is appropriate, while CPT® Code 96155 is designated for family encounters without the patient present.

1. Indications

The health and behavior intervention services represented by CPT® Code 96155 are indicated for various situations where family dynamics may exacerbate the health issues of a patient. These indications include, but are not limited to:

Family Dynamics Impacting Health The intervention is appropriate when family interactions and relationships are contributing to the patient's health problems.
Support for Caregivers Family members of terminally ill patients may require guidance on managing care, communication, and emotional support related to end-of-life issues.
Behavioral Issues in Children Parents of young children may seek intervention to learn behavior modification techniques to address anxiety or fear in their children.

2. Procedure

The procedure for health and behavior intervention services under CPT® Code 96155 involves several key steps that are executed during the face-to-face encounter with family members, excluding the patient. Each step is designed to facilitate effective communication and support within the family unit.

Assessment of Family Dynamics The provider begins by assessing the family dynamics and identifying specific issues that may be impacting the patient's health. This assessment is crucial for tailoring the intervention to the family's unique situation.
Education on Biopsychosocial Factors The provider educates family members about the biopsychosocial factors that influence health, helping them understand how their interactions and behaviors can affect the patient's well-being.
Instruction on Communication Skills The provider offers instruction on effective communication techniques, conflict resolution strategies, and problem-solving skills to enhance family interactions and support the patient’s health.
Implementation of Techniques Family members are guided through specific techniques, such as relaxation exercises, stress reduction methods, and social skills training, which they can practice both during the session and at home.
Follow-Up and Support The provider discusses follow-up strategies and ongoing support for family members, ensuring they have the resources and knowledge to continue applying the techniques learned during the intervention.

3. Post-Procedure

After the health and behavior intervention session, family members are expected to implement the techniques and strategies discussed during the encounter. This may involve practicing communication exercises, applying behavior modification techniques with children, or utilizing stress reduction methods in their daily lives. The provider may schedule follow-up sessions to assess progress, address any ongoing issues, and provide additional support as needed. It is important for family members to maintain open lines of communication with the provider to ensure that they are effectively managing the biopsychosocial factors related to the patient's care and overall health.

Short Descr	INTERV HLTH/BEHAV FAM NO PT
Medium Descr	HLTH&BEHAVIOR IVNTJ EA 15 MIN FAM W/O PT
Long Descr	Health and behavior intervention, each 15 minutes, face-to-face; family (without the patient present)
Status Code	Non-Covered Service
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	9 - Not Applicable
Multiple Procedures (51)	9 - Concept does not apply.
Bilateral Surgery (50)	9 - Concept does not apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	9 - Concept does not apply.
Co-Surgeons (62)	9 - Concept does not apply.
Team Surgery (66)	9 - Concept does not apply.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Non-Covered Service, not paid under OPPS
Type of Service (TOS)	9 - Other Medical Items or Services
Berenson-Eggers TOS (BETOS)	M5D - Specialist - other
MUE	Not applicable/unspecified.
CCS Clinical Classification	218 - Psychological and psychiatric evaluation and therapy