Health Behavior Assessment/Intervention

Revised: October 15, 2020

Health behavior assessment and intervention is intended to identify psychological, behavioral, emotional, cognitive and relevant social factors that can prevent, treat, or manage physical health problems. Services must be associated with the patient's primary diagnosis, which is physical in nature, and focus on factors that could complicate the medical condition and treatment.

Health behavior assessments or reassessments require a referral from a physician or nonphysician practitioner. Documentation must show evidence of coordination of care with the patient's primary medical care providers or medical provider responsible for the medical management of the physical illness that the psychological assessment or intervention addresses.

Eligible Providers

· Licensed Mental Health Professionals

Eligible Members

To be eligible for a health behavior assessment or intervention, MHCP members must be one of the following:

· Hospitalized in a medical bed

· Receiving ongoing medical services in an outpatient setting

Covered Services

These services are for member’s who have a primary physical diagnoses who may benefit from assessments and interventions that focus on the biopsychosocial factors related to the patient's health status. These services are used to identify the following factors which are important to the prevention, treatment and management of physical health problems:

· Behavioral

· Cognitive

· Emotional

· Psychological

· Social

Covered health and behavior assessments and reassessments include:

· Health-focused clinical interviews

· Behavioral observations

· Clinical decision-making

· Evaluation of the patient's response to physical health problems, outlook and coping strategies, and adherence to treatment plans

Health behavior intervention services are intended to:

· Modify the psychological, behavioral, emotional, cognitive, and social factors relevant to and affecting the patient's physical health problems.

· Focus on promoting functional improvement, lessening the psychosocial and psychological obstacles to recovery, and improvement of the patient's coping skills related to the medical condition.

· Family interventions should emphasize active member or family engagement and participation.

If further evaluation of the member’s psychological status is required to determine if a person has a mental illness or emotional disturbance, a mental health professional must conduct a mental health diagnostic assessment.

Noncovered Services

A Health behavior assessment does not qualify as a mental health diagnostic assessment; do not use to identify whether a member has or does not have a mental illness or emotional disturbance.

Preventive medicine counseling and risk factor reduction interventions are not covered.

Billing

· Use the MN–ITS 837P to bill for health behavior services

· Enter the treating provider NPI number for each provider rendering services on each claim line item

· If the visit is in an inpatient setting, enter place of service code 21

· Use modifier U7 when billing for interns or residents

· Comply with CMS National Correct Coding Initiative (NCCI) standards

· Do not use health and behavior assessment procedure codes when billing for physician evaluation and management services

Health Behavior Assessment and Intervention
Procedure Code	Brief Description
96156	Health behavior assessment, or reassessment
96158	Health behavior intervention, individual, face-to-face; initial 30 minutes
96159	Health behavior intervention, individual, face-to-face; each additional 15 minutes (Used in conjunction with 96158)
96164	Health behavior intervention, group (2 or more patients), face-to-face; initial 30 minutes
96165	Health behavior intervention, group (2 or more patients), face-to-face; each additional 15 minutes (Used in conjunction with 96164)
96167	Health behavior intervention, family (with the patient present), face-to-face; initial 30 minutes
96168	Health behavior intervention, family (with the patient present), face-to-face; each additional 15 minutes (Used in conjunction with 96167)
96170	Health behavior intervention, family (without the patient present), face-to-face; initial 30 minutes
96171	Health behavior intervention, family (without the patient present), face-to-face; each additional 15 minutes (Used in conjunction with 96170)

Legal References

Minnesota Statute 256B.0625, subdivision 3
Minnesota Statute 256B.0625 subdivision, 4