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H & B Codes at a Glance
Medicare and a growing number of private insurers
reimburse psychologists for H & B services. The
six H & B codes, the service involved with each
code and national Medicare reimbursement
amounts for 2012 appear in the chart below.
The national payment amounts noted in the
chart are subject to a geographic adjustment.
Psychologists should check with their local
Medicare Administrative Contractor (MAC) for
the exact payment rate in their geographic area.
Initial assessment of the patient to determine the biopsychosocial factors affecting the patient’s physical health and any
15 min. ( 1 unit): $20.42
1 hour ( 4 units): $81.68
Reassessment of the patient to evaluate the patient’s condition
and determine the need for further treatment. A reassessment
may be performed by a clinician other than the one who
conducted the patient’s initial assessment.
15 min. ( 1 unit): $19.74
1 hour ( 4 units): $78.96
Intervention service provided to an individual to modify the
behavioral, cognitive and biopsychosocial factors affecting
the patient’s physical health. Examples include increasing
the patient’s awareness about his or her disease and using
cognitive and behavioral approaches to initiate physician-prescribed diet and exercise regimens.
15 min. ( 1 unit): $18.72
1 hour ( 4 units): $74.88
Intervention service provided to a group. An example is
a smoking-cessation program that includes educational
information, cognitive-behavioral treatment and social
15 min. ( 1 unit): $4.42
1 hour ( 4 units): $17.68
Note: Payment amount is per person.
The total group fee equals the amount
above multiplied by the number of
persons in the group.
Intervention service provided to a family with the patient
present. For example, a psychologist could use relaxation
techniques with both a diabetic child and his or her parents
to reduce the child’s fear of receiving injections and the
parents’ tension when administering the injections.
15 min. ( 1 unit): $18.38
1 hour ( 4 units): $73.52
Intervention service provided to a family without the
patient present. An example would be working with parents
and siblings to shape a diabetic child’s behavior.
Important note: Medicare and many private insurers exclude
coverage for 96155 since the patient is not present for the intervention.
Medicare does not pay
for this H & B code.
*Current Procedural Terminology (CPT®) Copyright 2011. American Medical Association. All rights reserved.