Health and behavior assessment procedures are used to identify the psychological, behavioral, emotional, cognitive, and social factors important to the prevention, treatment, or management of physical health problems.
The focus of the assessment is not on mental health but on the biopsychosocial factors important to physical health problems and treatments. The focus of the intervention is to improve the patient’s health and well-being utilizing cognitive, behavioral, social, and/or psychophysiological procedures designed to ameliorate specific disease-related problems.
Codes 96150-96155 describe services offered to patients who present with primary physical illnesses, diagnoses, or symptoms and may benefit from assessments and interventions that focus on the biopsychosocial factors related to the patient’s health status …
96150 health and behavior assessment (e.g., health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient, initial assessment
96152 health and behavior intervention, each 15 minutes, face-to-face; individual
96153 group (2 or more patients)
96154 family (with the patient present)
96155 family (without the patient present).
Each of the H/B codes refers to a 15-minute intervention; interventions requiring more time are billed by reporting multiple units of service. For example, a 30-minute assessment would be billed as two units of 96150. Currently, these codes are used most often by clinical psychologists.
The use of these codes and the delivery of the behavioral health services they represent are growing. Table 6-2 shows Medicare trend data for reimbursement of these services during 2003–2005 as reported by the American Psychological Association. All Medicare carriers now reimburse claims for services using these codes (except 96155, which Medicare does not cover). Although the extent to which private insurers and state Medicaid programs reimburse for these codes is not comprehensively tracked, in early 2007 an American Psychological Association list serve contained anecdotal reports of denial of reimbursement for these services by Medicaid, and coverage by private-sector health plans is not yet uniform.8
8Personal communication, Alan Nessman, American Psychological Association, March 27, 2007.