Every year the American Medical Association (AMA) releases updates to the Current Procedural Terminology (CPT) code set to bring medical procedure documentation up to date as technologies and practices evolve over time. The 2020 updates went into effect on January 1st, 2020. Providers in the behavioral health space will be most impacted by the addition of new codes for health and behavior assessment and intervention services.
When coding for services provided, it’s important to consider the following limitations:
- These new codes can’t be reported on the same day as psychiatric services (90785-90899) or adaptive behavior services (97151-97158, 0362T, 0373T). If a client does require both services, the AMA instructs that only the predominant service be reported.
- The new codes can’t be reported on the same day as any Evaluation and Management (E/M) service codes (99401-99412) rendered by the same provider. The new codes can be reported on the same day as an E/M service as long as they are both performed by different, qualified providers.
- Intervention codes (96158, 96164, 96167, 96170) cannot be reported for less than 16 minutes of service, and intervention add-on codes (+96159, +96165, +96168, +96171) cannot be reported for less than 8 minutes of service.
Health Behavior Assessment or Re-Assessment Services
The biggest change to health behavior assessment codes is that they are no longer dependent on the duration of the assessment. Instead, one code, 96156, is used once per day to cover the entire duration of the service.
Health Behavior Intervention Services, Individual
The new codes apply to individual interventions. The new code 96158 should be used for the initial 30 minutes of the service and +96159 should be used to document additional time.
Health Behavior Intervention Services, Groups
These new codes apply to intervention services performed for groups and are billed for individual clients.
Family Health Behavior Intervention Services, with Client Present
These codes should only be used to report family health behavior interventions where the client is present.
Family Health Behavior Intervention Services, without Client Present
These codes are used to report family health behavior interventions where the client is not present. If you’re billing Medicare, it’s important to note that Medicare doesn’t usually cover services where the client is absent.
What does this mean for my SimplePractice account?
As of January 8, 2020, you’ll no longer see the deleted codes as defaults in our system, and you’ll see the new CPT codes listed above. As always, if you don’t see a relevant CPT code, you can create it on your Billing and Services page. If one of the deprecated codes is currently included as one of your practice’s Services, those will be preserved so you can make the updated fee changes you need for your practice.
To learn more about how to use these codes in your practice and adjust to the changes, please consult the following resources: