Health and Behavior Assessment/Intervention – Medical Policy Article

Health and Behavior Assessment and Intervention (HBAI) services (CPT 96156, 96158, 96159, 96164, 96165, 96167, 96168) are covered when the patient has an underlying physical illness or injury and documented biopsychosocial factors significantly affecting medical management, the patient has capacity for face-to-face evaluation, and psychological evaluation/intervention is required to manage the physical illness or ADLs. Reassessments require documented change in status; family-involved interventions require an actively participating family representative. Numerous exclusions apply, including services for education, general support, diversionary/recreational activities, certain CPTs (96170/96171), and biofeedback (90901), and claims must include supporting medical documentation and valid ICD-10-CM codes.

"Patient has an underlying physical illness or injury for which the HBAI service is intended."