CPT 96164: Group Counseling for Psychosocial Factors, First 30 Minutes
CPT code 96164 designates the initial 30 minutes of a face-to-face group intervention where a clinician—often a psychologist—provides counseling and strategies that target cognitive, emotional, social, and cultural factors affecting patients’ management of physical health problems. Nationally, this code captures multi-patient behavioral health services that intersect with chronic disease management, care coordination, and integrated behavioral-primary care models.
Key payers considered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise overview of use cases and clinical context for 96164, plus practical benchmarking and payer coverage notes where available. Readers will find: an explanation of the clinical service and typical settings, comparisons of payer coverage approaches, common billing considerations, and links to related service codes and documentation expectations. This resource is intended for clinicians, billing professionals, and policy analysts seeking a national-level summary of what CPT code 96164 represents and how it is used in practice.
Data not available in the input: specific payer policies, reimbursement rates, associated taxonomies, and ICD-10 mappings.
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Billing Code Overview
CPT code 96164 describes a group psychotherapy-style visit in which the provider, typically a psychologist, delivers counseling and strategies addressing cognitive, emotional, social, and cultural factors that affect management of patients’ physical health problems. This code represents the first 30 minutes of a face-to-face session conducted with two or more patients.
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Service type: Group behavioral health intervention focused on psychosocial factors influencing physical health management
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Typical site of service: Outpatient clinic or behavioral health practice providing face-to-face group sessions
Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult with a chronic medical condition (for example, type 2 diabetes or coronary artery disease) who attends a multidisciplinary outpatient visit that includes a behavioral health group session. The psychologist leads a face-to-face group of two or more patients for structured counseling focused on cognitive, emotional, social, and cultural barriers to managing the patient’s physical illness. The session lasts at least 30 minutes and includes education, coping strategies, problem-solving, and skills training to improve adherence, self-management, and lifestyle change.
Workflow: The patient is scheduled for a combined medical and behavioral health visit or referred by the primary care clinician. The psychologist documents group attendance, clinical content, participant interaction, time spent in the initial 30-minute unit (96164), and clinical goals. Medical staff verify eligibility, obtain consent for group participation, and coordinate scheduling. Billing identifies the session as the first 30 minutes of group health and behavior intervention and assigns the appropriate modifier(s) as required by payor policy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same provider on the same day | Use when an E/M visit is performed the same day as the group behavioral service and meets E/M documentation requirements. |
59 | Distinct procedural service | Use if multiple distinct services are billed that are not normally reported together; indicates a separate service. |
22 | Increased procedural services | Use when the work required to deliver the group session is substantially greater than typical and payor allows additional payment. |
52 | Reduced services | Use when the service is partially reduced or not completed as described by the code. |
53 | Discontinued procedure | Use when the group session was started but discontinued due to extenuating circumstances. |
95 | Synchronous telemedicine service rendered via real-time interactive audio and video | Use when the group health behavior intervention is delivered via approved telehealth platforms and the payor accepts 96164 for telehealth. |
93 | Synchronous telehealth service rendered via telephone or other real-time synchronous audio-only | Use when permitted by payor for audio-only group behavioral health sessions. |
76 | Repeat procedure or service by same provider | Use when the same group intervention is repeated during the same encounter and payor rules require indicating repetition. |
77 | Repeat procedure by another provider | Use when another professional repeats the group intervention on the same day. |
GT | Via interactive audio and video telecommunication systems (historical) | Use when payor still recognizes GT for telehealth delivery of group services. |
GQ | Via asynchronous telecommunication systems | Use when asynchronous delivery is permitted and supported by payor policy for the intervention. |
CR | Catastrophe/disaster related | Use when services are related to a declared disaster and payor requires this indicator. |
59 | Distinct procedural service | (Duplicate entry omitted) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
103K00000X | Clinical Psychologist | Primary specialty that commonly provides group health behavior interventions like 96164. |
101Y00000X | Physician Assistant | May co-manage or assist in integrated behavioral health programs; documents participation per state scope. |
1223N0002X | Health and Behavior Psychologist | Subspecialty focusing on behavioral interventions for physical health conditions; appropriate for this code. |
261QM0800X | Behavioral Health Clinician | May represent licensed clinical social workers or counselors involved in group interventions under supervision. |
163W00000X | Family Medicine | Primary care physicians coordinating integrated care who may refer to the psychologist for 96164. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
E11.9 | Type 2 diabetes mellitus without complications | Diabetes is commonly managed with behavioral group interventions addressing adherence, diet, and lifestyle. |
I10 | Essential (primary) hypertension | Hypertension management benefits from group education on lifestyle modification and adherence. |
F32.9 | Major depressive disorder, single episode, unspecified | Comorbid depression often impacts chronic disease management; group health-behavior interventions address mood and coping. |
E78.5 | Hyperlipidemia, unspecified | Lipid management includes behavioral counseling for diet, exercise, and medication adherence in groups. |
Z71.9 | Counseling, unspecified | General counseling related to health behavior change is a common indication for 96164. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
96165 | Health and behavior intervention, each additional 30 minutes, face-to-face with the patient; group | Used to report each additional 30-minute unit of the group intervention following the initial 96164. |
96150 | Health and behavior assessment or re-assessment; each 15 minutes | Used when an initial behavioral assessment is performed to identify cognitive/behavioral factors affecting medical conditions prior to group therapy. |
90853 | Group psychotherapy (other than of a multiple-family group) | Alternative group psychotherapy code; used when the clinical focus is psychotherapy rather than health behavior change. |
99213 | Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes | May be billed same day if E/M is separate and meets documentation for significant, separately identifiable service. |
99406 | Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes | Common adjunct behavioral counseling service that may occur in the same episode of care for medical patients. |