Wiki CPT 96156

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I did thanks. It states "other qualified healthcare professional" however CMS states Clinical Psychologist. I am trying to reule out that someone with LESSER education can or cannot provide (like an LPC LMFT). Being that this is a forum I was reaching out to read others' opinion.
 
I found this on a legal website, so I don't know if CMS agrees, but:
Qualified mental health professional means any one of the following: psychiatrist, psychiatric nurse, practicing psychologist, psychiatric social worker, an individual with at least a masters degree in a related human service field and two years of supervised clinical experience in mental health services or an individual with a baccalaureate degree in a related human service field and four years of supervised clinical experience in mental health services

**edited to add the link to the site (I like to provide sources):
 
lgardner said:
I found this on a legal website, so I don't know if CMS agrees, but:
Qualified mental health professional means any one of the following: psychiatrist, psychiatric nurse, practicing psychologist, psychiatric social worker, an individual with at least a masters degree in a related human service field and two years of supervised clinical experience in mental health services or an individual with a baccalaureate degree in a related human service field and four years of supervised clinical experience in mental health services

**edited to add the link to the site (I like to provide sources):
Click to expand...
Thank you - that is VERY helpful
 
Encoder Pro for Payers Professional has the following coding tip information on 96156.

This service is used to identify the assessment of a patient’s psychological, behavioral, emotional, cognitive, and social factors as they relate to the prevention, treatment, or management of conditions affecting the patient’s physical health. This code does not identify a service that focuses on the mental health of the patient, but rather on the biopsychosocial factors that are or could affect the treatment of or severity of the patient’s physical condition. This service is, however, used to modify the psychological, behavioral, emotional, cognitive, and social factors that are identified directly affecting the patient’s physiological functioning, disease status, health, and general well-being. The service is offered to those patients that have established illnesses or symptoms who have not been diagnosed with mental illness but does not represent preventive medical counseling or risk factor reduction interventions. For health and behavior assessment services performed by a physician or other qualified health care professional who may also report evaluation and management services, see the appropriate E/M or preventive medicine services section.​

Since a LPC and/or LMFT would not bill an E/M they should be able to bill this code. However, this is intended to be for physical conditions not mental or behavioral health conditions.

There is an LCD for Georgia for coverage of 96156 which you can find here: Health and Behavior Assessment/Intervention LCD L37638
 
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