CPT 0359T: Behavior Identification Assessment, Comprehensive
CPT code 0359T denotes a comprehensive behavior identification assessment conducted face-to-face by a physician or other qualified health care professional. It combines standardized and non-standardized testing, a detailed behavioral history, direct patient observation, caregiver interview, and generation of a formal report. This assessment supports diagnostic clarification and treatment planning for behavioral and developmental conditions and is increasingly important as behavioral health services expand in outpatient settings nationwide.
Key payers included in this analysis are Aetna, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical role of the code, how it relates to related assessment and psychotherapy services, and the typical sites of service where it is delivered. The content summarizes common use cases tied to neurodevelopmental and mental health diagnoses and highlights related billing codes clinicians may encounter.
This publication aims to inform billing staff, behavioral health clinicians, and policy analysts about the code's clinical intent, typical service context, and intersections with other assessment and therapy services. Data not available in the input for specific reimbursement benchmarks or payer-specific coverage policies.
Customize your policy alerts
Sign up for cpt 0359T policy alerts
Get alerted when payer policies referencing 0359T are released or updated.
Monitor payer policy activity
Billing Code Overview
CPT code 0359T describes a behavior identification assessment performed face-to-face by a physician or other qualified health care professional. The service includes administration of standardized and non-standardized tests, a detailed behavioral history, patient observation, caregiver interview, and preparation of a report.
Service Type: Comprehensive behavioral assessment
Typical Site of Service: Outpatient behavioral health clinic or office setting, including pediatric or adult behavioral health practices where clinician and patient/caregiver can meet face-to-face.
National Reimbursement Benchmarks
National commercial reimbursement for CPT 0359T centers around an average commercial (BUCA) rate of $329.60, with Cigna’s mean aligning at $329.60 and a median of $356.70. Cigna’s observed minimum is $288.20 and maximum $362.40, indicating Cigna spans the same central tendency as the BUCA aggregate while containing both lower and higher contract points.
Dispersion analysis using the interquartile range (P75 minus P25) shows a very tight spread for both BUCA and Cigna: $36.40 (BUCA P75 $362.40 minus P25 $288.20) and $36.40 for Cigna (P75 $362.40 minus P25 $288.20). Because both payers share identical P25 and P75 values, neither exhibits wider IQR-based dispersion than the other; both are equally tight in the central 50% of rates.