Should I Bill Using the New Health and Behavioral Assessment Codes?

Carolyn Buppert, NP, JD; Janet Baradell, PhD, RN, CS

Disclosures

April 29, 2004

Question

I enjoyed reading J. Baradell and C. Buppert's article entitled "Billing for Psychiatric Clinical Nurse Specialists Services Within the Medicare Program."[1] My question in response to this article is: If Medicare patients are being seen who are not diagnosed with mental illness, and may benefit from evaluation that focuses on the biopsychosocial factors related to the patient's physical health status, can I bill the Health and Behavioral Assessment Codes?

Response from Carolyn Buppert, NP, JD and Janet Baradell, PhD, RN, CS

The Health and Behavioral Assessment (HBA) codes were published in the Federal Register after being accepted and assigned relative values by the Center for Medicare and Medicaid Services in 2001.[2] They were included in the Current Procedural Terminology (CPT) manual[3] and the Medicare Fee Schedule in 2002.

The HBA codes are used to bill for services provided to patients who are not diagnosed with a psychiatric problem, but whose cognitive, emotional, social, or behavioral functioning affect prevention, treatment, or management of a physical health problem.

There are 6 types of services included in the HBA codes. The first 2 services include health and behavior assessment and reassessment (96150 and 96151, respectively). Services might include a clinical interview, observation, monitoring, or questionnaires to assess the impact of cognitive, emotional, social, or behavioral factors on a physical health problem.

There are 4 intervention services for improving a patient's health by modifying cognitive, emotional, social, and behavioral factors that affect prevention, treatment, or management of a specific health problem or symptom. The 4 health and behavior interventions are: individual (96152); group (96153); family and patient (96154); and family without the patient present (96155).

Interventions might include self-monitoring or teaching cognitive-behavioral techniques, relaxation, visualization, coping and social skills, communication and conflict resolution, smoking cessation, relapse prevention, and diet and exercise prescribed by a physician.

All of the codes require face-to-face time with the patient, and 2 of the codes are billed in 15-minute increments (96150 and 96152). Time parameters are not specified for the other 4 services.

Response from Carolyn Buppert, NP, JD and Janet Baradell, PhD, RN, CS

The codes were created for use by nonphysician providers and may be billed by advanced practice nurses (APNs), psychologists, social workers, and other healthcare providers. The services must be within the scope of practice for the provider.

Why use these codes? The HBA services are provided without meeting the requirements for the key components of an Evaluation and Management (E&M) service: obtaining a history, providing an examination, or making a medical decision. This characteristic distinguishes HBA services from E&M services and may be most appropriate in some situations. However, some of the assessment and intervention strategies used by providers of HBA services are also provided by APNs and are documented in the counseling and coordination of care when providing E&M services.

The financial impact of selecting an HBA code rather than an E&M code can be seen in the following examples:

HBA Service RVU Nurse Clinician Fee E&M Service RVU Nurse Clinician Fee
Assessment (30 minutes)
99150
0.50 $51.46 ($25.73 for each 15 minutes) Office, new patient (30 minutes) 99203 1.34 $91.62
Individual intervention (15 minutes)
99152
0.46 $23.55 Office, established patient (15 minutes) 99213 0.67 $50.27

RVU = relative value unit

As seen in the examples above, the evaluation and management component of a service increases the work value and provides a higher fee. While an APN may chose to provide an HBA service, the provision of an E&M service often more accurately reflects the scope of practice of an APN.



Response from Carolyn Buppert, NP, JD and Janet Baradell, PhD, RN, CS

  • When diagnosing or treating a patient with a psychiatric disorder;

  • When providing an evaluation and management service on the same day;

  • When conducting psychological testing; and

  • While patients complete self-administered questionnaires without face-to-face time (ie, before or after the service is provided).

In summary, the HBA codes were created for assessing cognitive, emotional, social, and behavioral factors that affect acute or chronic health problems or diseases, maintenance of health, or recovery from illness. APNs may bill for services using these codes; however, the use of E&M service codes more often accurately reflects the work value and scope of practice of the APN.



An extensive discussion of the new HBA codes is contained in the CPT Assistant.

[4]

The service descriptions and code numbers for each of the new codes are contained in the CPT manual beginning in 2002.

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