How To Use CPT Code 96171

CPT 96171 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. 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 96171?

CPT 96171 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, in a face-to-face session. This code represents each additional 15 minutes of face-to-face service with the patient’s family.

2. Official Description

The official description of CPT code 96171 is: ‘Health behavior intervention, family (without the patient present), 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 96170.

3. Procedure

1. The provider, typically a psychologist, conducts a face-to-face session with the patient’s family, without the patient present.
2. During the session, the provider interviews the family members and counsels them on strategies to change family dynamics and behaviors that adversely affect the patient’s physical health and coping behaviors.
3. The provider addresses family-related barriers to the patient’s self-management of chronic diseases and discusses interventions and strategies to help the patient overcome factors that result in noncompliance or hinder recovery.
4. The provider observes the interactions between family members and the patient’s behavior and responses.
5. Using cognitive and behavioral approaches, the provider encourages the patient and family members to change family dynamics and behaviors that adversely affect the patient’s coping skills and management of their medical illness.
6. The provider discusses next steps with the patient and the family.
7. CPT code 96171 should be reported for each additional 15 minutes of face-to-face service with the family without the patient present.

4. Qualifying circumstances

CPT 96171 is used when a psychologist or other qualified provider conducts a face-to-face session with the patient’s family, without the patient present, to address family-related barriers to the patient’s self-management of chronic diseases. 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 96171

CPT code 96171 should be used when a psychologist or other qualified provider conducts a face-to-face session with the patient’s family, without the patient present, to address family-related barriers to the patient’s self-management of chronic diseases. This code should be used for each additional 15 minutes of face-to-face service with the family.

6. Documentation requirements

To support a claim for CPT 96171, the provider must document the following information:

• Reason for the health behavior intervention and the need to address family-related barriers to the patient’s self-management of chronic diseases
• Date, start and end time of the face-to-face session with the patient’s family
• Topics discussed during the session, including interventions and strategies to change family dynamics and behaviors
• Observations of the patient’s behavior and responses to family members
• Next steps discussed with the patient and the family

7. Billing guidelines

When billing for CPT 96171, ensure that the provider conducting the session is a psychologist or other qualified provider. Use this code for each additional 15 minutes of face-to-face service with the patient’s family without the patient present. Report CPT code 96170 for the initial 30 minutes of the health behavior intervention. Do not report CPT code 96171 in conjunction with mental illness diagnosis codes or psychotherapy services codes.

8. Historical information

CPT 96171 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 45-minute face-to-face session with the patient’s family to address family-related barriers to the patient’s self-management of chronic diseases.
2. A qualified provider conducting a 60-minute face-to-face session with the patient’s family to counsel them on strategies to change family dynamics and behaviors that adversely affect the patient’s physical health and coping behaviors.
3. A psychologist conducting a 75-minute face-to-face session with the patient’s family to observe the interactions between family members and the patient’s behavior and responses.
4. A qualified provider conducting a 90-minute face-to-face session with the patient’s family to encourage them to change family dynamics and behaviors that adversely affect the patient’s coping skills and management of their medical illness.
5. A psychologist conducting a 105-minute face-to-face session with the patient’s family to discuss interventions and strategies that will help the patient overcome factors that result in noncompliance or hinder recovery.
6. A qualified provider conducting a 120-minute face-to-face session with the patient’s family to discuss next steps in addressing family-related barriers to the patient’s self-management of chronic diseases.
7. A psychologist conducting a 135-minute face-to-face session with the patient’s family to address family-related barriers to the patient’s self-management of chronic diseases.
8. A qualified provider conducting a 150-minute face-to-face session with the patient’s family to counsel them on strategies to change family dynamics and behaviors that adversely affect the patient’s physical health and coping behaviors.
9. A psychologist conducting a 165-minute face-to-face session with the patient’s family to observe the interactions between family members and the patient’s behavior and responses.