CPT 0359T: Behavior Identification Assessment, Comprehensive - OpenPayer

Summary & Overview

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.

AetnaCigna HealthUnitedHealthcareMedicare0359TCPTbehavioral-assessmentbehavior-identificationoutpatient-mental-healthpsychological-testingclinical-assessment

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.

Clinical & Coding Specifications

Clinical Context

A 9-year-old child is referred by a pediatrician for a comprehensive behavior identification assessment after caregivers report concerns about social communication delays, repetitive behaviors, inattention, and escalating anxiety at school. The evaluation is scheduled as a face-to-face visit with the caregiver(s) and patient present. The clinician (a licensed psychologist) conducts a detailed behavioral history with caregivers, administers standardized measures for autism spectrum disorder symptoms and attention/behavior screening tools, performs direct observation of the child interacting with caregivers and during structured tasks, and integrates non-standardized clinician observations. The session includes a caregiver interview to gather developmental, medical, educational, and psychosocial history, scoring of administered instruments, and preparation of a formal interpretive report summarizing findings, diagnostic impressions, and recommended supports.

Clinical workflow:

Referral triage and chart review of prior records and school reports.
Scheduling of a single extended face-to-face assessment visit with caregiver(s) and patient present.
Administration and scoring of standardized and non-standardized instruments during the visit; real-time observation of patient behavior.
Caregiver interview covering developmental milestones, behavior patterns across settings, medical history, and current concerns.
Clinician synthesis and preparation of a written report documenting assessment methods, test results, behavioral observations, and diagnostic impressions.
Communication of results to referring provider and provision of recommendations to caregivers and school teams as appropriate.

Coding Specifications

Related Codes

0366

CPT 0366T: Deleted Cardiology Outpatient Hospital Procedure Code

cpt-0366t-interventional-cardiovascular-procedure-deleted

CPT 0366T: Deleted Interventional Cardiovascular Procedure

cpt-97155-adaptive-behavior-treatment-with-protocol-modification

CPT 97155: Adaptive Behavior Treatment with Protocol Modification

0371

CPT 0371T: Non-Invasive Central Arterial Pressure Analysis

0373

CPT 0373T: Adaptive Behavior Treatment with Protocol Modification

cpt-0363t-adaptive-behavior-treatment-protocol-technician

CPT 0363T: Adaptive Behavior Treatment by Protocol, Technician-Administered

cpt-0369t-duodenal-mucosal-resurfacing-endoscopic

CPT 0369T: Duodenal Mucosal Resurfacing, Endoscopic

97158

CPT 97158: Group Adaptive Behavior Treatment with Protocol Modification

cpt-0364t-behavior-treatment-outpatient-therapy

CPT 0364T: Behavior Treatment, Outpatient Behavioral Therapy

cpt-0367t-adaptive-behavior-treatment-deleted

CPT 0367T: Adaptive Behavior Treatment (deleted)

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Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure	When an unrelated E/M visit is furnished on the same day as the assessment and meets E/M documentation requirements
`59`	Distinct procedural service	When another distinct service or procedure is performed that is not typically reported together and is separate from the assessment
`52`	Reduced services	When the behavioral assessment is partially reduced or not completed as originally planned
`76`	Repeat procedure by same provider	When the behavioral assessment is repeated by the same provider during the global period or same visit
`77`	Repeat procedure by another provider	When another provider repeats the behavioral assessment
`22`	Increased procedural services	When the assessment requires substantially greater work than typical (document rationale and time)
`24`	Unrelated E/M service during postoperative period	If the assessment is unrelated to a recent surgical postoperative period but an E/M is provided
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	If components are delivered via live interactive telehealth (only when payer permits for this code)
`GT`	Via interactive audio and video telecommunication systems	If the payer requires this legacy modifier for telehealth delivery
`59`	Distinct procedural service	When billing to differentiate from related follow-up or testing services (repeat for emphasis if used for differentiation)

Taxonomy Code	Specialty	Notes
`103T00000X`	Psychologist	Typically performs standardized behavioral testing, observation, interpretation, and report preparation
`1041C0700X`	Clinical Social Worker	Performs caregiver interview, behavioral history, and non-standardized assessments; may prepare psychosocial portions of the report
`101YM0800X`	Mental Health Counselor	Conducts behavioral interviews, observations, and provides documentation for behavioral identification assessments

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F84.0`	Autistic disorder	Primary diagnosis often evaluated via behavioral identification assessment to characterize social communication deficits and restricted, repetitive behaviors
`F90.9`	Attention-deficit hyperactivity disorder, unspecified type	Assessment identifies attention, hyperactivity, and impulsivity patterns contributing to functional impairment and informs differential diagnosis
`F41.9`	Anxiety disorder, unspecified	Assessment helps determine behavioral manifestations of anxiety and distinguishes anxiety-driven behaviors from other neurodevelopmental conditions
`F32.9`	Major depressive disorder, single episode, unspecified	Behavioral assessment can identify depressive symptoms affecting behavior, motivation, and social engagement
`F43.23`	Adjustment disorder with mixed anxiety and depressed mood	Assessment documents behavioral changes related to psychosocial stressors and guides recommendations for supports and interventions

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`0360T`	Behavioral follow-up assessment	Used for periodic reassessment or short interval follow-up after the initial `0359T` assessment to document progress or response to interventions
`96130`	Psychological testing evaluation services by physician or qualified health care professional, first hour	May be billed when in-depth test interpretation and report preparation for psychological testing are provided in conjunction with or in addition to the behavioral assessment
`96136`	Psychological or neuropsychological test administration and scoring, first 30 minutes	Billed for time spent administering and scoring standardized instruments during the assessment when time-based test administration is reported separately
`90834`	Psychotherapy, 45 minutes with patient	May be billed for a separate psychotherapy session provided to the patient distinct from the assessment visit; cannot be billed together unless separate, distinct service requirements are met