CPT® Code 96202

Official Description

Multiple-family group behavior management/modification training for parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of parent(s)/guardian(s)/caregiver(s); initial 60 minutes

Common Language Description

The CPT® Code 96202 refers to a specialized service known as multiple-family group behavior management or modification training. This procedure is designed for the parent(s), guardian(s), or caregiver(s) of patients who have a mental or physical health diagnosis. The training is conducted by a physician or another qualified healthcare professional and is performed face-to-face with multiple sets of caregivers, without the patient being present. The primary objective of this training is to equip caregivers with the skills necessary to modify and manage problematic behaviors exhibited by the patient. This is achieved through techniques such as operant conditioning, which involves the use of consequences and rewards to encourage positive behavior changes. During the session, caregivers learn various interventions that can be applied to effectively manage the patient's responses to their illness. This includes structuring the patient's environment in a way that promotes desired behaviors while minimizing the negative impact of the illness on daily life. The training aims to enhance compliance with the patient's care plan and treatment regimen by providing caregivers with practical strategies for behavior management. The healthcare professional may utilize a range of teaching methods, including verbal instruction, live or recorded demonstrations, role-playing with feedback, and other interactive techniques to facilitate learning. It is important to note that this training is not intended to serve as risk management, preventive medicine counseling, support group therapy, or merely informational lecturing about the patient's condition. The focus is on empowering caregivers with active interventions that can be employed in managing patient behavior and modifying stimulus responses as part of the treatment process. For billing purposes, the initial 60 minutes of this training is reported using code 96202, while additional time spent in training can be reported with code 96203 for each subsequent 15 minutes.

1. Indications

The procedure represented by CPT® Code 96202 is indicated for the following scenarios:

Behavioral Issues: When caregivers need to address problematic or objectionable behavior patterns exhibited by patients with mental or physical health diagnoses.
Support for Caregivers: To provide training and support for parent(s), guardian(s), or caregiver(s) in managing the patient's responses to their illness effectively.
Enhancing Compliance: To improve adherence to the patient's care plan and treatment by equipping caregivers with practical skills and strategies.
Environmental Structuring: When caregivers require guidance on how to structure the patient's environment to reinforce desired behaviors and mitigate the impact of the illness on daily life.

2. Procedure

The procedure for CPT® Code 96202 involves several key steps that are essential for effective behavior management training:

Initial Assessment: The healthcare professional begins by assessing the specific needs of the caregivers and the behaviors that require modification. This assessment helps tailor the training to address the unique challenges faced by the caregivers in managing the patient's behavior.
Training Session: The training is conducted face-to-face with multiple sets of caregivers. During this session, the healthcare professional provides comprehensive instruction on behavior management techniques, focusing on operant conditioning principles, which include the use of rewards and consequences to encourage positive behavior changes.
Interactive Learning: Various teaching methods are employed to enhance understanding and retention of the material. This may include live demonstrations, recorded examples, and role-playing exercises where caregivers can practice the techniques in a supportive environment. Feedback is provided to reinforce learning and address any questions or concerns.
Implementation Strategies: Caregivers are taught specific interventions that they can implement in their daily interactions with the patient. This includes strategies for managing the patient's responses to their illness and structuring the environment to promote desired behaviors.
Follow-Up and Support: The session concludes with a discussion on the importance of ongoing support and follow-up. Caregivers are encouraged to continue practicing the skills learned and to seek additional guidance as needed to ensure effective behavior management.

3. Post-Procedure

After the completion of the training session, caregivers are expected to apply the skills and strategies learned in their interactions with the patient. It is important for caregivers to monitor the patient's behavior and make adjustments to their approach as necessary. Ongoing communication with the healthcare professional may be beneficial to address any challenges that arise and to reinforce the techniques taught during the training. Caregivers should also be aware of the need for additional training sessions if further support is required, particularly if new behaviors emerge or if the patient's condition changes. The goal is to ensure that caregivers feel confident and equipped to manage the patient's behavior effectively, thereby improving the overall treatment experience.

Short Descr	MLT FAM GRP BHV TRAIN 1ST 60
Medium Descr	MLT FAM GROUP BHV MGMT/MODIFICAJ TRAING 1ST 60
Long Descr	Multiple-family group behavior management/modification training for parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of parent(s)/guardian(s)/caregiver(s); initial 60 minutes
Status Code	Active Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Service Paid under Fee Schedule or Payment System other than OPPS
Berenson-Eggers TOS (BETOS)	none
MUE	1

This is a primary code that can be used with these additional add-on codes.

96203

Telehealth Service (Medicare) Add-on Code MPFS Status: Active Code APC A Multiple-family group behavior management/modification training for parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of parent(s)/guardian(s)/caregiver(s); each additional 15 minutes (List separately in addition to code for primary service)

59	Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
95	Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system.
GW	Service not related to the hospice patient's terminal condition