Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.30
    OpenPayerBilling CodesHealth Behavior Assessment and Intervention ProceduresCPT cpt-96168-family-behavioral-health-family-counseling-15min
    Ask Trek AI about this page

    CPT 96168: Family Interview and Counseling, 15-Minute Increment

    Medicare pays $29 on average nationally for this procedure.

    CPT code 96168 describes an additional 15 minutes of face-to-face family interview and counseling provided by a qualified mental health clinician (typically a psychologist) where the patient’s family is interviewed in the presence of the patient to address family dynamics and behaviors that negatively affect the patient’s physical health and coping; service type: family interview and counseling, typical site of service: outpatient behavioral health or clinic settings involving the patient and family members in the same session.

    For related coverage guidance, see recent payer policy updates: Pediatric Neurodevelopmental and Autism Spectrum Disorder (ASD) Screening Corporate Medical Policy, Inhaled Nitric Oxide Therapy (for New Mexico Only), Inhaled Nitric Oxide Therapy (for North Carolina Only).

    Customize your policy alerts

    Sign up for cpt 96168 policy alerts

    Get alerted when payer policies referencing 96168 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Table of contents

    Progress1 / 7

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Clinical & Coding Specifications

    Clinical Context

    A 14-year-old adolescent with poorly controlled Type 1 diabetes presents for routine endocrinology follow-up. The patient demonstrates frequent missed insulin boluses and erratic blood glucose logs. The treating pediatric endocrinologist refers the family for family-focused behavioral intervention. A licensed psychologist meets with the patient and family during a scheduled 45-minute visit in the outpatient behavioral health clinic. The psychologist spends the first 15 minutes reviewing medical adherence, then provides two additional 15-minute segments of family counseling addressing caregiver communication, mealtime routines, and problem-solving strategies that affect the patient’s diabetes management. Documentation includes time spent face-to-face with the family in the presence of the patient, specific behavioral targets, techniques taught, family members present, and the effect on the patient’s self-management.

    Typical site of service: outpatient behavioral health clinic or ambulatory specialty clinic associated with the medical practice.

    Service type: family psychotherapy/counseling with the patient present; time-based face-to-face family intervention recorded in 15-minute increments using additional-unit coding for extended segments beyond the initial family psychotherapy visit.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    90847Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutesUsed for longer family psychotherapy sessions; 96168 represents each additional 15 minutes of face-to-face family counseling in certain coding structures; 90847 may be billed when psychotherapy rather than psychological testing or time-based add-on coding is appropriate.
    96110Developmental testing, limited (eg, Denver II, early language/communication screening), with interpretation and reportMay be performed in the same visit to assess developmental factors impacting family dynamics and adherence.
    96136Psychological or neuropsychological test administration and scoring by clinician, first 30 minutesUsed when psychological testing is performed in the same episode of care to evaluate patient cognition or behavior that informs family counseling.
    99401Preventive medicine counseling, individual, 15 minutesPreventive counseling for adolescents on health behaviors may occur alongside family counseling; bill separately only if criteria for separate service are met.
    90791Psychiatric diagnostic evaluation (no medical services)May be performed before family psychotherapy to establish psychiatric diagnoses affecting family functioning and adherence.

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    95Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    103K00000X
    103T00000X
    2084P0800X
    2279P3900X
    207RT0003X
    261QS1000X
    364SW0102X
    347B00000X

    Related ICD-10-CM Codes

    29 rows

    ICD-10-CM CodeDescription
    F32.9Major depressive disorder, single episode, unspecified
    F33.1Major depressive disorder, recurrent, moderate
    F34.1Dysthymic disorder
    F41.1Generalized anxiety disorder
    F41.9Anxiety disorder, unspecified
    F43.10Post-traumatic stress disorder, unspecified
    F43.20Adjustment disorder, unspecified
    F43.21Adjustment disorder with depressed mood
    F50.9Eating disorder, unspecified
    F54Psychological and behavioral factors associated with disorders or diseases classified elsewhere

    Showing 1–10 of 29

    Related Payer Policy Updates

    Specialty: Pediatrics/Neonatology1 / 3

    10 rows

    PolicyPayerEffective Date
    Pediatric Neurodevelopmental and Autism Spectrum Disorder (ASD) Screening Corporate Medical Policybcbsvermont2026-12-01
    Inhaled Nitric Oxide Therapy (for New Mexico Only)UnitedHealthcare2026-10-01
    Inhaled Nitric Oxide Therapy (for North Carolina Only)UnitedHealthcare2026-10-01
    Inhaled Nitric Oxide Therapy (for Pennsylvania Only)UnitedHealthcare2026-10-01
    Inhaled Nitric Oxide Therapy (for Kentucky Only)UnitedHealthcare2026-10-01
    Clinical Policy: NICU Apnea Bradycardia GuidelinesAmbetter Nevada2026-10-01
    DRG Newborn Inpatient Stays - FacilityBlue Cross Blue Shield - Maine2026-10-01
    Pediatric Preventive ScreeningOscar Health2026-10-01
    Infant Nutritional FormulaCigna2026-09-15
    Pediatric Preventive ScreeningBlue Cross Blue Shield - New Mexico2026-09-04

    Related Codes

    CPT-96156-HEALTH-BEHAVIOR-ASSESSMENT

    CPT 96156: Health Behavior Assessment, General Health Factors

    CPT-96158-BEHAVIORAL-HEALTH-COUNSELING-HEALTH-MANAGEMENT-30-MIN

    CPT 96158: Psychological Counseling for Health Management

    CPT-96159-INDIVIDUAL-HEALTH-MANAGEMENT-COUNSELING-15MIN

    CPT 96159: Additional 15-Min Individual Behavioral Counseling

    CPT-96160-STANDARDIZED-RISK-QUESTIONNAIRE-SCREENING-SCORING

    CPT 96160: Standardized Questionnaire for Health Risk Screening and Scoring

    CPT-96161-CAREGIVER-RISK-SCREENING-QUESTIONNAIRE-ASSESSMENT

    CPT 96161: Caregiver Risk Questionnaire Assessment

    CPT-96164-GROUP-BEHAVIORAL-HEALTH-COUNSELING-30-MIN

    CPT 96164: Group Counseling for Cognitive/Emotional Management, 30 min

    CPT-96165-GROUP-COUNSELING-COGNITIVE-EMOTIONAL-HEALTH-MANAGEMENT

    CPT 96165: Group Counseling for Health Behavior, Additional 15 Min

    CPT-96167-FAMILY-INTERVIEW-COUNSELING-INITIAL-30-MINUTES

    CPT 96167: Family Interview and Counseling, Initial 30 Minutes

    CPT-96170-FAMILY-BEHAVIORAL-HEALTH-INTERVIEW-COUNSELING-INITIAL-30-MINUTES

    CPT 96170: Family Psychotherapy Without Patient, Initial 30 Minutes

    CPT-96171-FAMILY-INTERVENTION-WITHOUT-PATIENT

    CPT 96171: Family Counseling, Patient Not Present, per 15 Minutes

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.