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Thread: Health/Behavior assessment with E/M

  1. #1

    Default Health/Behavior assessment with E/M

    AAPC: Back to School
    We have a new provider for a pain clinic that wants to report Health and Behavior assessment codes 96150 and 96151 when he does the initial E/M (99214) evaluation. Everything I find says we cannot report these together but he is sure that his coders made this work at his previous employment--but doesn't know how. I've been considering either using higher E/M code 99215, or, adding Prolonged Physician Service code 99354 -- depending on what documentation gives me.

    Does anyone have experience in this situation or thoughts on the best way to capture the E/M visit and the Health and Behavior Assessment portion of the provider's visit?

    Thank you for any thoughts,

    Alisa, CPC

  2. #2


    Is your new provider a clinical psychologist? Because these codes can only be used by them. Here is a link to my local Medicare carrier, WPS, and their policy on these codes.


    I didn't read through the whole LCD so I don't know if they say in writing you can't bill the health & behavior codes with an E/M but, if you check in CCI, the 96150 will bundle into the E/M and no modifier can bypass the edit.

    Lisi, CPC

  3. #3


    I have two pain practices which administer psych testing to qualify pts for neurostimulators. One uses 96102 (administered by a technician) and the other uses 96103 (administered by a computer) these are mandated tests so I also append modifier 32. As far as I know we are getting paid for the testing and the E/M code.

  4. #4
    Join Date
    Apr 2007
    St. Joseph County, Indiana


    This question is more for hgolfos...

    At your clinics, who is giving the tests and which tests are they giving? They may be completely correct.

    Typically, I have only seen assessments by outside pysch providers for stimulators and pumps. I preach to providers to take these assessments seriously since there is not a small incidence of pt's later rejecting the implanted device.

    Brock Berta

  5. #5


    We don't do those services here where I am, so I'm not an expert about this... but the CPT book states that "E&M services codes (including Counseling Risk Factor Reduction and Behavior Change Intervention 99401-99412) should not be reported on the same day" and "For health and behavior assessment and/or intervention performed by a physician, see E&M or Preventive Medicine codes".
    My guess would be it depends on who is the provider of the services.

  6. #6


    at the pain clinic where they use the computerized test, the physician has the pt take the test then they send it in to be evaluated by the company. At the other one, there is a trained tech in the office who administers the written test and then our physician checks off on it before it is sent in to the company for eval. I don't have the test name at my fingertips at the moment. From what I've seen, those patients on the neurostimulators, have had fairly good results thus far.

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