Health and Behavior Assessment and Intervention - Professional Reimbursement Policy
Defines Anthem's commercial reimbursement stance for Health and Behavior Assessment and Intervention professional services (CPT codes 96156-96171), including who may bill and when services are separately reimbursable; applies to Anthem Blue Cross commercial plans subject to contract and state/federal mandates.
No material clinical or coverage changes in this revision.
Coverage Criteria for HBAI Services
HBAI coverage criteria
Covered when ALL of the following are met:
ALL of the following
- Services are rendered by a qualified non-physician behavioral healthcare professional.
- Services are reported with a primary medical diagnosis of an acute or chronic physical illness.
Not separately reimbursable when ANY of the following apply:
- Services are reported by a physician or other qualified healthcare professional who is licensed to report evaluation and management or preventative medicine services.
- Services are reported with a primary mental health or psychiatric diagnosis.
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.