How To Use CPT Code 96170

CPT 96170 describes the health behavior intervention provided by a psychologist or other qualified provider to the patient’s family, without the patient present, in a face-to-face session lasting 30 minutes. 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 96170?

CPT 96170 can be used to describe the health behavior intervention services provided by a psychologist or other qualified provider to the patient’s family, without the patient present. This code is used when the provider spends 30 minutes in a face-to-face session with the patient’s family, counseling them on strategies to change family dynamics and behaviors that adversely affect the patient’s physical health and coping behaviors.

2. Official Description

The official description of CPT code 96170 is: ‘Health behavior intervention, family (without the patient present), face-to-face; initial 30 minutes.’

3. Procedure

1. The provider, typically a psychologist, interviews the patient’s family and counsels them on strategies to change family dynamics and behaviors that adversely affect the patient’s physical health and coping behaviors.
2. This code represents the initial 30 minutes of face-to-face service with the patient’s family without the patient present.

4. Qualifying circumstances

Patients eligible to receive CPT 96170 services are those who have a chronic disease or illness that requires family-related barriers to be addressed for effective self-management. The provider, typically a psychologist, addresses intellectual, cultural, psychophysiological, and emotional factors that result in noncompliance or hinder recovery. The patient is not present during the session, and the focus is on changing family dynamics and behaviors that adversely affect the patient’s coping skills and management of their medical illness.

5. When to use CPT code 96170

CPT code 96170 should be used when a qualified provider, typically a psychologist, provides a 30-minute face-to-face session with the patient’s family to address family-related barriers to self-management of the patient’s chronic disease. This code should only be used when the patient is not present during the session.

6. Documentation requirements

To support a claim for CPT 96170, the provider must document the following information:

• Specific details about the patient’s chronic disease or illness
• Observations and interactions with the patient’s family members
• Interventions and strategies discussed during the session
• Next steps and recommendations for the patient and the family
• Signature of the provider who conducted the session

7. Billing guidelines

When billing for CPT 96170, ensure that the provider conducting the session is a qualified professional, typically a psychologist. The session should be face-to-face with the patient’s family for 30 minutes, and the patient should not be present. There are additional codes available for reporting each additional 15 minutes of face-to-face health behavior intervention with the patient’s family.

8. Historical information

CPT 96170 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 counseling the family of a patient with diabetes on strategies to improve family dynamics and behaviors that affect the patient’s self-management.
2. A qualified provider addressing cultural factors within the patient’s family that hinder the patient’s recovery from a chronic illness.
3. A psychologist working with the family of a patient with a mental health condition to develop coping strategies and improve family support.
4. A provider conducting a session with the family of a patient with a chronic disease to address communication barriers and improve the patient’s adherence to medical treatment.
5. A psychologist counseling the family of a patient with a physical health problem on strategies to promote health behaviors and improve the patient’s overall well-being.
6. A qualified provider working with the family of a patient with a chronic illness to address emotional factors that impact the patient’s coping skills and management of their medical condition.
7. A psychologist counseling the family of a patient with a chronic disease on strategies to improve family communication and support the patient’s self-management.
8. A provider conducting a session with the family of a patient with a chronic illness to address behavioral factors that hinder the patient’s recovery and overall health.
9. A qualified provider working with the family of a patient with a chronic condition to develop a plan for managing stress and improving the patient’s coping skills.
10. A psychologist counseling the family of a patient with a chronic illness on strategies to improve family dynamics and behaviors that affect the patient’s self-management.