Summary & Overview
CPT 97152: Behavior Identification-Supporting Assessment, Technician-Administered
CPT code 97152 represents a behavior identification-supporting assessment, a critical service in behavioral health care. This procedure involves a technician conducting a face-to-face evaluation of a patient under the supervision of a physician or other qualified healthcare professional, with each unit representing 15 minutes of service. The code is widely used in office settings to support the identification and assessment of behavioral health conditions, including autism spectrum disorder, attention-deficit hyperactivity disorder, anxiety, depression, and post-traumatic stress disorder.
Major national payers such as Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare recognize and reimburse for CPT 97152, reflecting its importance in the delivery of behavioral health services. Readers will gain insight into the clinical context of this code, its role in supporting behavioral health assessments, and its relationship to other related CPT codes. The publication also covers common billing modifiers and associated provider taxonomies, offering a comprehensive overview of how this code is utilized in practice. Policy updates and benchmarks relevant to behavioral health billing are included to inform stakeholders about current trends and requirements.
CPT Code Overview
CPT 97152 is used to report a behavior identification-supporting assessment administered face-to-face by one technician under the direction of a physician or other qualified healthcare professional. This service is part of the behavioral health category and is typically performed in an office setting (Place of Service 11). The assessment is billed in 15-minute increments and is designed to support the identification and evaluation of behavioral health needs in patients.
Clinical & Coding Specifications
Clinical Context
A child diagnosed with autism spectrum disorder (F84.0) is referred to a behavioral health clinic by their primary care physician. During the initial visit, a technician, under the supervision of a psychologist, conducts a face-to-face behavior identification-supporting assessment. This assessment is performed in the office setting (Place of Service 11) and involves observing the patient's behaviors, collecting data, and supporting the development of a treatment plan. The procedure is billed in 15-minute increments using CPT code 97152. The supervising provider may be a psychologist, mental health counselor, or clinical social worker, depending on the patient's needs and the clinic's staffing.
Coding Specifications
-
Modifiers:
-
Modifier
59: Distinct Procedural Service. Used when97152is performed separately from other procedures on the same day to indicate it is a distinct service. -
Modifier
76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. Used when97152is performed more than once by the same provider on the same day.
-
-
Provider Taxonomies: