How To Use CPT Code 96164

CPT 96164 describes the health behavior intervention services provided by a psychologist or other qualified provider to a group of two or more patients in a face-to-face setting. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 96164?

CPT 96164 can be used to describe the health behavior intervention services provided by a psychologist or other qualified provider to a group of two or more patients in a face-to-face setting. This code represents the initial 30 minutes of the service, during which the provider addresses barriers to self-management of chronic diseases and discusses interventions and strategies to help patients overcome factors that hinder recovery or result in noncompliance.

2. Official Description

The official description of CPT code 96164 is: ‘Health behavior intervention, group (2 or more patients), face-to-face; initial 30 minutes.’

3. Procedure

1. The provider, typically a psychologist, conducts a 30-minute face-to-face session with a group of two or more patients.
2. During the session, the provider addresses barriers to self-management of chronic diseases and discusses interventions and strategies to help patients overcome factors that hinder recovery or result in noncompliance.
3. The provider guides the patients on improved coping skills and removal of psychological barriers to the management of their chronic medical illness.
4. Patients may role-play strategies and discuss their success or lack thereof, with additional guidance from the provider on adjusting their coping skills.
5. CPT code 96164 represents the first 30 minutes of face-to-face health behavior intervention services for a group of two or more patients.

4. Qualifying circumstances

CPT 96164 is used when a psychologist or other qualified provider conducts a face-to-face health behavior intervention session with a group of two or more patients. The session aims to address barriers to self-management of chronic diseases and improve coping skills. The patients must have been referred by their primary care physicians and must be dealing with chronic medical illnesses that require management.

5. When to use CPT code 96164

CPT code 96164 should be used when a psychologist or other qualified provider conducts a 30-minute face-to-face health behavior intervention session with a group of two or more patients. This code represents the initial 30 minutes of the service. If the session extends beyond 30 minutes, additional time should be reported using CPT code 96165.

6. Documentation requirements

To support a claim for CPT 96164, the provider must document the following information:

• Specific details of the health behavior intervention session, including the topics discussed and strategies provided
• Date, start and end time of the session
• Number of patients in the group
• Progress made by the patients and any additional sessions scheduled
• Signature of the provider conducting the session

7. Billing guidelines

When billing for CPT 96164, ensure that the provider conducting the session is a qualified psychologist or other qualified provider. The session must be face-to-face with a group of two or more patients. If the session extends beyond 30 minutes, report additional time using CPT code 96165. Do not report CPT code 96164 in conjunction with mental illness diagnosis codes or psychotherapy services codes.

8. Historical information

CPT 96164 was added to the Current Procedural Terminology system on January 1, 2020. There have been no updates to the code since its addition.

9. Examples

1. A psychologist conducting a 30-minute face-to-face health behavior intervention session with a group of three patients, addressing barriers to self-management of their chronic diseases.
2. A qualified provider leading a 30-minute face-to-face health behavior intervention session with a group of five patients, discussing strategies to improve coping skills and overcome factors that hinder recovery.
3. A psychologist conducting a 30-minute face-to-face health behavior intervention session with a group of four patients, guiding them on improved coping skills and removal of psychological barriers to the management of their chronic medical illnesses.
4. A qualified provider leading a 30-minute face-to-face health behavior intervention session with a group of two patients, addressing barriers to self-management of their chronic diseases and discussing interventions to improve compliance.
5. A psychologist conducting a 30-minute face-to-face health behavior intervention session with a group of six patients, discussing strategies to overcome intellectual, cultural, psychophysiological, and emotional factors that result in noncompliance or hinder recovery.
6. A qualified provider leading a 30-minute face-to-face health behavior intervention session with a group of three patients, guiding them on improved coping skills and discussing interventions to help them manage their chronic medical illnesses.
7. A psychologist conducting a 30-minute face-to-face health behavior intervention session with a group of four patients, addressing barriers to self-management of their chronic diseases and discussing strategies to improve their coping skills.
8. A qualified provider leading a 30-minute face-to-face health behavior intervention session with a group of five patients, discussing interventions and strategies to help them overcome factors that hinder recovery or result in noncompliance.
9. A psychologist conducting a 30-minute face-to-face health behavior intervention session with a group of two patients, guiding them on improved coping skills and removal of psychological barriers to the management of their chronic medical illnesses.