How To Use CPT Code 96165

CPT 96165 describes the health behavior intervention services provided by a psychologist or other qualified provider in a group setting with two or more patients. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 96165?

CPT 96165 can be used to describe the health behavior intervention services provided by a psychologist or other qualified provider in a group setting with two or more patients. This code represents each additional 15 minutes of this service, which involves counseling and strategies for managing cognitive, emotional, social, and cultural factors that impact the management of the patients’ physical health problems.

2. Official Description

The official description of CPT code 96165 is: ‘Health behavior intervention, group (2 or more patients), face-to-face; each additional 15 minutes (List separately in addition to code for primary service).’ This code should be used in conjunction with CPT code 96164 for the initial 30 minutes of the service.

3. Procedure

1. The psychologist or qualified provider conducts a face-to-face session with a group of two or more patients.
2. They address barriers to self-management of the patients’ chronic diseases, discussing interventions and strategies to overcome intellectual, cultural, psychophysiological, and emotional factors that hinder recovery or result in noncompliance.
3. The provider guides the patients on improved coping skills and removal of psychological barriers to managing their chronic medical illnesses.
4. Patients may role-play strategies and discuss their success or lack thereof, receiving additional guidance from the provider on adjusting their coping skills.
5. For each additional 15 minutes of face-to-face health behavior intervention with two or more patients, report CPT code 96165 along with CPT code 96164 for the initial 30 minutes.

4. Qualifying circumstances

CPT 96165 is appropriate when a psychologist or qualified provider addresses barriers to self-management of chronic diseases in a group setting with two or more patients. The focus is on helping patients overcome cognitive, emotional, social, and cultural factors that hinder recovery or result in noncompliance. This code should not be reported in conjunction with mental illness diagnosis codes or psychotherapy services codes.

5. When to use CPT code 96165

CPT code 96165 should be used when a psychologist or qualified provider conducts a health behavior intervention session in a group setting with two or more patients. This code should be reported for each additional 15 minutes of the service, in addition to CPT code 96164 for the initial 30 minutes.

6. Documentation requirements

To support a claim for CPT code 96165, the psychologist or qualified provider must document the following information:

• Specific established underlying diagnosis
• Health-focused clinical interview, behavioral observations, and clinical decision-making
• Date, start and end time of the session
• Topics discussed and strategies provided to address barriers to self-management
• Progress made by the patients and any additional sessions scheduled
• Signature of the psychologist or qualified provider providing the service

7. Billing guidelines

When billing for CPT code 96165, ensure that the service is provided by a psychologist or qualified provider in a group setting with two or more patients. Report CPT code 96164 for the initial 30 minutes of the service, and CPT code 96165 for each additional 15 minutes. Do not report CPT code 96165 in conjunction with mental illness diagnosis codes or psychotherapy services codes.

8. Historical information

CPT code 96165 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 group health behavior intervention session with two or more patients to address barriers to self-management of their chronic diseases.
2. A qualified provider leading a group session to help patients improve their coping skills and overcome psychological barriers to managing their physical health problems.
3. A psychologist guiding a group of patients in role-playing strategies to address cognitive, emotional, and social factors that impact their recovery from chronic illnesses.
4. A qualified provider discussing interventions and strategies with a group of patients to promote health-promoting behaviors and adherence to medical treatment.
5. A psychologist facilitating a group session to help patients adjust their coping skills and remove cultural barriers to managing their physical health problems.
6. A qualified provider conducting a group health behavior intervention session to address psychophysiological factors that hinder recovery or result in noncompliance.
7. A psychologist leading a group session to help patients overcome intellectual barriers and improve their self-management of chronic diseases.
8. A qualified provider guiding a group of patients in discussing their success and lack thereof in managing their physical health problems, providing additional guidance on adjusting their coping skills.
9. A psychologist conducting a group health behavior intervention session to address emotional factors that impact the patients’ recovery from chronic illnesses.
10. A qualified provider facilitating a group session to help patients overcome social barriers and improve their adherence to medical treatment.