Until now, almost all intervention codes used by psychologists involved psychotherapy and required a mental health diagnosis, such as under the DSM-IV. In contrast, health and behavior assessment and intervention services focus on patients whose primary diagnosis is physical in nature.
Use of the codes will enable reimbursement for the delivery of psychological services for an individual whose problem is a physical illness and does not have a mental health diagnosis.
The codes capture services addressing a wide range of physical health issues, such as patient adherence to medical treatment, symptom management, health-promoting behaviors, health-related risk-taking behaviors, and overall adjustment to physical illness. In almost all of these cases a physician will already have diagnosed the patient’s physical health problem. Physical health diagnoses are typically represented by ICD-10 CM codes (see the CDC website).
If a psychologist is treating a patient with both a physical and mental illness he or she must pay careful attention to how each service is billed. The health and behavior codes cannot be used for psychotherapy services addressing the patient’s mental health diagnosis, nor can they be billed on the same day as a psychiatric CPT code (90785-90899). The psychologist must report the predominant service performed.
Use of the codes will enable reimbursement for the delivery of psychological services for an individual whose problem is a physical illness and does not have a mental health diagnosis.
Health Behavior Assessment Services Assessment or Reassessment Reimbursement Table
Health Behavior Assessment Services Assessment or reassessment Demystified
All providers should become familiar with the new codes so you know when and how to use them. Be sure you coordinate with your billing support or vendors, including your billing software vendor or Electronic Data Interchange (EDI) clearinghouse, to make sure they are ready.
CPT code 96156 is used to describe health behavior assessment, or re-assessment, that is conducted through health-focused clinical interviews, observation and clinical decision-making.
Assessment services are now event-based and CPT code 96156 is billed only once per day regardless of the amount of time required to complete the overall service.
Only report 96156 for assessment of a patient with a primary diagnosis that is physical in nature.
Do not report 96156 on the same day as psychiatric services (90785-90899) or adaptive behavior services (97151-97158, 0362T, 0373T).
For patients that require psychiatric services or adaptive behavior services, as well as health behavior assessment/intervention, report the predominant service performed.
Evaluation and Management (E/M) services codes, including counseling risk factor reduction and behavior change intervention (99401-99412), should not be reported on the same day as health behavior assessment and intervention codes by the same provider:
These services can occur and be reported on the same date of service as long as the E/M service (99401-99412) is performed by a physician or other qualified health care professional (QHP) who may report evaluation and management services.
However, health behavior assessment and/or intervention services performed by a physician or other QHP who may report E/M services should do so using codes found in the E/M Services or Preventive Medicine Services sections of the CPT® Manual.
Guidelines: Health and Behavior Assessment/Intervention services (96156, 96158, 96159, 96164, 96165, 96167, 96168, 96170, 96171)
AMA Guidelines:
These codes are used to report services provided face-to-face by a physician or other qualified health care professional for the purpose of promoting health and preventing illness or injury. They are distinct from evaluation and management (E/M) services that may be reported separately when performed. Risk factor reduction services are used for persons without a specific illness for which the counseling might otherwise be used as part of treatment.
Preventive medicine counseling and risk factor reduction interventions will vary with age and should address such issues as family problems, diet and exercise, substance use, sexual practices, injury prevention, dental health, and diagnostic and laboratory test results available at the time of the encounter.
Behavior change interventions are for persons who have a behavior that is often considered an illness itself, such as tobacco use and addiction, substance abuse/misuse, or obesity. Behavior change services may be reported when performed as part of the treatment of condition(s) related to or potentially exacerbated by the behavior or when performed to change the harmful behavior that has not yet resulted in illness. Any E/M services reported on the same day must be distinct, and time spent providing these services may not be used as a basis for the E/M code selection. Behavior change services involve specific validated interventions of assessing readiness for change and barriers to change, advising a change in behavior, assisting by providing specific suggested actions and motivational counseling, and arranging for services and follow-up.
For counseling groups of patients with symptoms or established illness, use 99078.
Health Net’s telehealth grant gives members an alternative and convenient means to address their mental healthcare concerns
Health Net has grant funded a proposal by Insight Choices, in partnership with Carenodes, to expand virtual healthcare delivery capacity and accessibility. In response to the ongoing COVID-19 pandemic, Insight Choices, a coalition of psychiatric providers across California were awarded a $125,000 telehealth infrastructure expansion grant by Health Net.
The grant will help Insight Choices launch new telehealth technologies to increase its prevention and intervention efforts for patients with mental health conditions. Furthermore, availability of funding will enable the provision of crisis intervention services, mental and substance use disorder treatment, crisis counseling, and other related supports for communities impacted by the COVID-19 pandemic.
Earlier this year, Health Net announced it would award $13.4 million in immediate assistance for Medi-Cal providers to expand telehealth capacity and capabilities at California safety net clinics, Federally Qualified Health Centers (FQHC), and independent provider practices.
“Providing increased access to care during this unprecedented time is critical to ensuring our most vulnerable populations stay healthy and safe. The amount of difficult news, confusion and tragedy surrounding all of us in a short period of time can feel insurmountable. Reaching out for help is incredibly important and telehealth is key to ensuring access to care is not interrupted.”
Brian Ternan, President and CEO, Health Net of California and California Health & Wellness.
Recognizing the urgency of the situation, Insight Choices saw the need to increase its telehealth offering to benefit its patients who are coping with increased anxiety, deep depression and unfortunately, suicidal ideation. The organization is also seeing an increased need to provide mental health services for health care workers on the frontline of the pandemic.
“Health care providers throughout California are under incredible, and still increasing, strain as they work diligently to fight this pandemic, and for our patients, the strain they feel is just as, if not more difficult to handle,” said Robert Chang, DO, Medical Director & President at Insight Choices. “As we focus on mental health care and the emotional wellbeing of the Californians we serve, these funds will provide Insight Choices the support needed to deliver a robust response to the mental health needs exasperated by the COVID-19 pandemic.”
“Our nation’s health care providers are under incredible, and still increasing, strain as they fight the pandemic. Insight Choices plan for the COVID-19 Telehealth Program is a critical tool to address this national emergency—starting in California and the counties we serve with a focus on mental health care and emotional wellbeing. This grant will provide Insight Choices, and the communities it serves, vital funding to assist in a more robust response to the mental health crisis exasperated by the COVID-19 pandemic,”
Alex Yarijanian CEO of Carenodes and Interim COO of Insight Choices
Social distancing has led many across the nation to seek out health providers that offer telehealth to ease the anxiety of walking into a clinic, and this is no different for mental health clinics. Telehealth can also bring costs down for some patients and is a benefit to those without a mode of transportation. However, many providers and organizations that serve Medi-Cal patients face financial barriers to expand the implementation, and this is where organizations like Health Net come in.
Insight Choices and Carenodes, will support infrastructure modernization efforts to include telecommunications services, information services and devices necessary to enable the provision of telehealth services during this emergency period. In addition, such capacity building funds have the potential to substantially stimulate the deployment of innovative access to care models.
About Insight Choices Insight Choices Psychiatry and Behavioral Health Services offer a full range of assessment and treatment options to address the mental, emotional and behavioral problems that occur throughout life. The group’s programs encompass a comprehensive view of mental health integrating the biological, psychological and social dimensions of care. Serving populations across California with expanded hours (nights and weekends), telehealth availability, evidence-based treatment modalities, and engagement via technology and virtual means, Insight Choices leads access to care.
About Carenodes Carenodes leads healthcare infrastructure development efforts around integrating nonmedical services within mainstream healthcare (primary care, behavioral, substance abuse, payers). It focuses on developing provider networks with the capacity to deliver on the promise of a ‘biopsychosocial model of wellbeing’ and equity in access to healthcare.
About Health Net: At Health Net, we believe every person deserves a safety net for their health, regardless of age, income, employment status or current state of health. Founded 40 years ago, we remain dedicated to transforming the health of our community, one person at a time. Today, Health Net’s 3,000 employees and 85,000 network providers serve more than 3 million members. That’s nearly 1 in 12 Californians. Health Net of California, Inc., Health Net Life Insurance Company and Health Net Community Solutions, Inc. These entities are wholly owned subsidiaries of Centene Corporation (NYSE: CNC), a Fortune 100 company providing health coverage to more than 20 million Americans.
Alex Yarijanian 