Local Coverage Article Billing and Coding

Billing and Coding: Health and Behavior Assessment/Intervention

A56562

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Contractor Information

Article Information

General Information

Article ID
A56562
Article Title
Billing and Coding: Health and Behavior Assessment/Intervention
Article Type
Billing and Coding
Original Effective Date
05/16/2019
Revision Effective Date
10/01/2022
Revision Ending Date
N/A
Retirement Date
N/A
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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) states that no payment shall be made to any provider for any claim which lacks the necessary information to process the claim.

 

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Health and Behavior Assessment/Intervention L37638.

CPT® code 90901 Biofeedback is also not covered as a health and behavioral intervention.

Coding Information

CPT/HCPCS Codes

Group 1

(10 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
96156 Hlth bhv assmt/reassessment
96158 Hlth bhv ivntj indiv 1st 30
96159 Hlth bhv ivntj indiv ea addl
96164 Hlth bhv ivntj grp 1st 30
96165 Hlth bhv ivntj grp ea addl
96167 Hlth bhv ivntj fam 1st 30
96168 Hlth bhv ivntj fam ea addl
96170 Hlth bhv ivntj fam wo pt 1st
96171 Hlth bhv ivntj fam w/o pt ea
G2214 Init/sub psych care m 1st 30

Group 2

Group 2 Paragraph

N/A

Group 2 Codes

N/A

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
XX000 Not Applicable

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(193 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
F11.120 Opioid abuse with intoxication, uncomplicated
F11.121 Opioid abuse with intoxication delirium
F11.122 Opioid abuse with intoxication with perceptual disturbance
F11.129 Opioid abuse with intoxication, unspecified
F11.13 Opioid abuse with withdrawal
F11.150 Opioid abuse with opioid-induced psychotic disorder with delusions
F11.151 Opioid abuse with opioid-induced psychotic disorder with hallucinations
F11.159 Opioid abuse with opioid-induced psychotic disorder, unspecified
F11.220 Opioid dependence with intoxication, uncomplicated
F11.221 Opioid dependence with intoxication delirium
F11.222 Opioid dependence with intoxication with perceptual disturbance
F11.229 Opioid dependence with intoxication, unspecified
F11.250 Opioid dependence with opioid-induced psychotic disorder with delusions
F11.251 Opioid dependence with opioid-induced psychotic disorder with hallucinations
F11.259 Opioid dependence with opioid-induced psychotic disorder, unspecified
F11.91 Opioid use, unspecified, in remission
F11.920 Opioid use, unspecified with intoxication, uncomplicated
F11.921 Opioid use, unspecified with intoxication delirium
F11.922 Opioid use, unspecified with intoxication with perceptual disturbance
F11.929 Opioid use, unspecified with intoxication, unspecified
F11.950 Opioid use, unspecified with opioid-induced psychotic disorder with delusions
F11.951 Opioid use, unspecified with opioid-induced psychotic disorder with hallucinations
F11.959 Opioid use, unspecified with opioid-induced psychotic disorder, unspecified
F12.120 Cannabis abuse with intoxication, uncomplicated
F12.121 Cannabis abuse with intoxication delirium
F12.122 Cannabis abuse with intoxication with perceptual disturbance
F12.129 Cannabis abuse with intoxication, unspecified
F12.13 Cannabis abuse with withdrawal
F12.150 Cannabis abuse with psychotic disorder with delusions
F12.151 Cannabis abuse with psychotic disorder with hallucinations
F12.159 Cannabis abuse with psychotic disorder, unspecified
F12.220 Cannabis dependence with intoxication, uncomplicated
F12.221 Cannabis dependence with intoxication delirium
F12.222 Cannabis dependence with intoxication with perceptual disturbance
F12.229 Cannabis dependence with intoxication, unspecified
F12.250 Cannabis dependence with psychotic disorder with delusions
F12.251 Cannabis dependence with psychotic disorder with hallucinations
F12.259 Cannabis dependence with psychotic disorder, unspecified
F12.91 Cannabis use, unspecified, in remission
F12.920 Cannabis use, unspecified with intoxication, uncomplicated
F12.921 Cannabis use, unspecified with intoxication delirium
F12.922 Cannabis use, unspecified with intoxication with perceptual disturbance
F12.929 Cannabis use, unspecified with intoxication, unspecified
F12.950 Cannabis use, unspecified with psychotic disorder with delusions
F12.951 Cannabis use, unspecified with psychotic disorder with hallucinations
F12.959 Cannabis use, unspecified with psychotic disorder, unspecified
F13.120 Sedative, hypnotic or anxiolytic abuse with intoxication, uncomplicated
F13.121 Sedative, hypnotic or anxiolytic abuse with intoxication delirium
F13.129 Sedative, hypnotic or anxiolytic abuse with intoxication, unspecified
F13.130 Sedative, hypnotic or anxiolytic abuse with withdrawal, uncomplicated
F13.131 Sedative, hypnotic or anxiolytic abuse with withdrawal delirium
F13.132 Sedative, hypnotic or anxiolytic abuse with withdrawal with perceptual disturbance
F13.139 Sedative, hypnotic or anxiolytic abuse with withdrawal, unspecified
F13.150 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions
F13.151 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations
F13.159 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified
F13.220 Sedative, hypnotic or anxiolytic dependence with intoxication, uncomplicated
F13.221 Sedative, hypnotic or anxiolytic dependence with intoxication delirium
F13.229 Sedative, hypnotic or anxiolytic dependence with intoxication, unspecified
F13.250 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions
F13.251 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations
F13.259 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified
F13.91 Sedative, hypnotic or anxiolytic use, unspecified, in remission
F13.920 Sedative, hypnotic or anxiolytic use, unspecified with intoxication, uncomplicated
F13.921 Sedative, hypnotic or anxiolytic use, unspecified with intoxication delirium
F13.929 Sedative, hypnotic or anxiolytic use, unspecified with intoxication, unspecified
F13.950 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions
F13.951 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations
F13.959 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified
F14.120 Cocaine abuse with intoxication, uncomplicated
F14.121 Cocaine abuse with intoxication with delirium
F14.122 Cocaine abuse with intoxication with perceptual disturbance
F14.129 Cocaine abuse with intoxication, unspecified
F14.13 Cocaine abuse, unspecified with withdrawal
F14.150 Cocaine abuse with cocaine-induced psychotic disorder with delusions
F14.151 Cocaine abuse with cocaine-induced psychotic disorder with hallucinations
F14.159 Cocaine abuse with cocaine-induced psychotic disorder, unspecified
F14.220 Cocaine dependence with intoxication, uncomplicated
F14.221 Cocaine dependence with intoxication delirium
F14.222 Cocaine dependence with intoxication with perceptual disturbance
F14.229 Cocaine dependence with intoxication, unspecified
F14.250 Cocaine dependence with cocaine-induced psychotic disorder with delusions
F14.251 Cocaine dependence with cocaine-induced psychotic disorder with hallucinations
F14.259 Cocaine dependence with cocaine-induced psychotic disorder, unspecified
F14.91 Cocaine use, unspecified, in remission
F14.920 Cocaine use, unspecified with intoxication, uncomplicated
F14.921 Cocaine use, unspecified with intoxication delirium
F14.922 Cocaine use, unspecified with intoxication with perceptual disturbance
F14.929 Cocaine use, unspecified with intoxication, unspecified
F14.93 Cocaine use, unspecified with withdrawal
F14.950 Cocaine use, unspecified with cocaine-induced psychotic disorder with delusions
F14.951 Cocaine use, unspecified with cocaine-induced psychotic disorder with hallucinations
F14.959 Cocaine use, unspecified with cocaine-induced psychotic disorder, unspecified
F15.120 Other stimulant abuse with intoxication, uncomplicated
F15.121 Other stimulant abuse with intoxication delirium
F15.122 Other stimulant abuse with intoxication with perceptual disturbance
F15.129 Other stimulant abuse with intoxication, unspecified
F15.13 Other stimulant abuse with withdrawal
F15.150 Other stimulant abuse with stimulant-induced psychotic disorder with delusions
F15.151 Other stimulant abuse with stimulant-induced psychotic disorder with hallucinations
F15.159 Other stimulant abuse with stimulant-induced psychotic disorder, unspecified
F15.220 Other stimulant dependence with intoxication, uncomplicated
F15.221 Other stimulant dependence with intoxication delirium
F15.222 Other stimulant dependence with intoxication with perceptual disturbance
F15.229 Other stimulant dependence with intoxication, unspecified
F15.250 Other stimulant dependence with stimulant-induced psychotic disorder with delusions
F15.251 Other stimulant dependence with stimulant-induced psychotic disorder with hallucinations
F15.259 Other stimulant dependence with stimulant-induced psychotic disorder, unspecified
F15.91 Other stimulant use, unspecified, in remission
F15.920 Other stimulant use, unspecified with intoxication, uncomplicated
F15.921 Other stimulant use, unspecified with intoxication delirium
F15.922 Other stimulant use, unspecified with intoxication with perceptual disturbance
F15.929 Other stimulant use, unspecified with intoxication, unspecified
F15.950 Other stimulant use, unspecified with stimulant-induced psychotic disorder with delusions
F15.951 Other stimulant use, unspecified with stimulant-induced psychotic disorder with hallucinations
F15.959 Other stimulant use, unspecified with stimulant-induced psychotic disorder, unspecified
F16.120 Hallucinogen abuse with intoxication, uncomplicated
F16.121 Hallucinogen abuse with intoxication with delirium
F16.122 Hallucinogen abuse with intoxication with perceptual disturbance
F16.129 Hallucinogen abuse with intoxication, unspecified
F16.150 Hallucinogen abuse with hallucinogen-induced psychotic disorder with delusions
F16.151 Hallucinogen abuse with hallucinogen-induced psychotic disorder with hallucinations
F16.159 Hallucinogen abuse with hallucinogen-induced psychotic disorder, unspecified
F16.220 Hallucinogen dependence with intoxication, uncomplicated
F16.221 Hallucinogen dependence with intoxication with delirium
F16.229 Hallucinogen dependence with intoxication, unspecified
F16.250 Hallucinogen dependence with hallucinogen-induced psychotic disorder with delusions
F16.251 Hallucinogen dependence with hallucinogen-induced psychotic disorder with hallucinations
F16.259 Hallucinogen dependence with hallucinogen-induced psychotic disorder, unspecified
F16.91 Hallucinogen use, unspecified, in remission
F16.920 Hallucinogen use, unspecified with intoxication, uncomplicated
F16.921 Hallucinogen use, unspecified with intoxication with delirium
F16.929 Hallucinogen use, unspecified with intoxication, unspecified
F16.950 Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder with delusions
F16.951 Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder with hallucinations
F16.959 Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder, unspecified
F17.220 Nicotine dependence, chewing tobacco, uncomplicated
F17.221 Nicotine dependence, chewing tobacco, in remission
F17.229 Nicotine dependence, chewing tobacco, with unspecified nicotine-induced disorders
F18.120 Inhalant abuse with intoxication, uncomplicated
F18.121 Inhalant abuse with intoxication delirium
F18.129 Inhalant abuse with intoxication, unspecified
F18.150 Inhalant abuse with inhalant-induced psychotic disorder with delusions
F18.151 Inhalant abuse with inhalant-induced psychotic disorder with hallucinations
F18.159 Inhalant abuse with inhalant-induced psychotic disorder, unspecified
F18.220 Inhalant dependence with intoxication, uncomplicated
F18.221 Inhalant dependence with intoxication delirium
F18.229 Inhalant dependence with intoxication, unspecified
F18.250 Inhalant dependence with inhalant-induced psychotic disorder with delusions
F18.251 Inhalant dependence with inhalant-induced psychotic disorder with hallucinations
F18.259 Inhalant dependence with inhalant-induced psychotic disorder, unspecified
F18.91 Inhalant use, unspecified, in remission
F18.920 Inhalant use, unspecified with intoxication, uncomplicated
F18.921 Inhalant use, unspecified with intoxication with delirium
F18.929 Inhalant use, unspecified with intoxication, unspecified
F18.950 Inhalant use, unspecified with inhalant-induced psychotic disorder with delusions
F18.951 Inhalant use, unspecified with inhalant-induced psychotic disorder with hallucinations
F18.959 Inhalant use, unspecified with inhalant-induced psychotic disorder, unspecified
F19.120 Other psychoactive substance abuse with intoxication, uncomplicated
F19.121 Other psychoactive substance abuse with intoxication delirium
F19.122 Other psychoactive substance abuse with intoxication with perceptual disturbances
F19.129 Other psychoactive substance abuse with intoxication, unspecified
F19.130 Other psychoactive substance abuse with withdrawal, uncomplicated
F19.131 Other psychoactive substance abuse with withdrawal delirium
F19.132 Other psychoactive substance abuse with withdrawal with perceptual disturbance
F19.139 Other psychoactive substance abuse with withdrawal, unspecified
F19.150 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder with delusions
F19.151 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder with hallucinations
F19.159 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder, unspecified
F19.220 Other psychoactive substance dependence with intoxication, uncomplicated
F19.221 Other psychoactive substance dependence with intoxication delirium
F19.222 Other psychoactive substance dependence with intoxication with perceptual disturbance
F19.229 Other psychoactive substance dependence with intoxication, unspecified
F19.250 Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder with delusions
F19.251 Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder with hallucinations
F19.259 Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder, unspecified
F19.91 Other psychoactive substance use, unspecified, in remission
F19.920 Other psychoactive substance use, unspecified with intoxication, uncomplicated
F19.921 Other psychoactive substance use, unspecified with intoxication with delirium
F19.922 Other psychoactive substance use, unspecified with intoxication with perceptual disturbance
F19.929 Other psychoactive substance use, unspecified with intoxication, unspecified
F19.950 Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with delusions
F19.951 Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with hallucinations
F19.959 Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder, unspecified
G30.0 - G31.1 Alzheimer's disease with early onset - Senile degeneration of brain, not elsewhere classified
G31.83 - G31.84 Neurocognitive disorder with Lewy bodies - Mild cognitive impairment of uncertain or unknown etiology

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

N/A

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
10/01/2022 R6

Under ICD-10 Codes that DO NOT Support Medical Necessity Group 1: Codes added F11.91, F12.91, F13.91, F14.91, F15.91, F16.91, F18.91 and F19.91 and descriptors were revised for G31.83 and G31.84. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/1/22.

01/01/2021 R5

Under CPT/HCPCS Codes Group 1: Codes added G2214.

This revision is due to the Q1 2021 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 1/1/2021.

10/01/2020 R4

Under ICD-10 Codes that Support Medical Necessity Group1: Codes added F11.13, F12.13, F13.130, F13.131, F13.132, F13.139, F14.13, F14.93, F15.13, F19.130, F19.131, F19.132 and F19.139.This revision is due to the Annual ICD-10 Updates and is effective on 10/1/2020.

01/01/2020 R3

Under CPT/HCPCS Codes Group 1: Codes CPT® codes 96156, 96158, 96159, 96164, 96165, 96167, 96168, 96170 and 96171 were added, 96150, 96151, 96152, 96153, 96154 and 96155 were deleted. 

This revision is due to the 2020 Annual CPT/HCPCS Code Update and is effective on January 1, 2020.

10/10/2019 R2

Revisions were made to the Billing and Coding: Health and Behavior Assessment/Intervention A56562 Article. This article is being revised in order to adhere to CMS requirements per Chapter 13, Section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Title XVIII of the Social Security Act, §1833(e) was removed from the CMS National Coverage Policy section of the related Health and Behavior Assessment/Intervention L37638 LCD and placed in this article.

05/16/2019 R1

All coding located in the Coding Information section has been removed from the related Health and Behavior Assessment/Intervention L37638 LCD and added to this article.

Associated Documents

Related Local Coverage Documents
LCDs
L37638 - Health and Behavior Assessment/Intervention
Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
08/23/2022 10/01/2022 - N/A Currently in Effect You are here
02/03/2021 01/01/2021 - 09/30/2022 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Health and Behavior
  • Behavior