Summary & Overview
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.
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. |