Fillable Printable Form 320E
Fillable Printable Form 320E
Form 320E
320-10
CHAPTER 300
MEDICAL POLICY FOR AHCCCS COVERED SERVICES
POLICY 320
SERVICES WITH SPECIAL CIRCUMSTANCES
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
AHCCCS MEDICAL POLICY MANUAL
320-E
HEALTH AND BEHAVIOR INTERVENTION
REVISION DATES: 03/01/14, 10/01/13, 05/01/07
INITIAL
EFFECTIVE DATE:
10/01/2006
DESCRIPTION
Health and behavioral assessment procedures (CPT codes 96150-96155) are used to
identify and treat the psychological, behavioral, emotional, cognitive and social factors
important to the prevention, treatment and management of physical health problems. The
focus of the assessment is not on mental health, but on the stresses, expectations, lifestyle
and perceptions that are associated with the underlying medical condition. Codes 96150 -
96155 describe services offered to members who present with primary physical illnesses,
diagnosis or symptoms and may benefit from assessments and interventions that focus on
the biopsychosocial factors related to the member's health. These services do not
represent preventative medicine counseling and risk factor reduction interventions.
Therefore, evaluation and management services codes (including preventative medicine,
individual counseling codes 99401-99404 and preventative medicine, group counseling
codes 99411- 99412) should not be reported on the same day.
AMOUNT, DURATION AND SCOPE
AHCCCS covers medically necessary health and behavioral assessment procedures (CPT
codes 96150-96155). The focus of the assessment/interventions is not on mental health
but the biopsychosocial factors important to physical health problems and treatment. The
focus of the intervention is to improve the member's health and well-being utilizing
cognitive, behavioral, social, and/or psychophysiological procedures designed to
ameliorate specific disease-related problems.
Individuals requiring the service(s) described above must not be referred to the Integrated
Regional Behavioral Health Authorities (Integrated RBHAs) or Regional Behavioral
Health Authorities (RBHAs).
CODES
96150- Health and behavior assessment (e.g. health-focused clinical interview, behavioral
observations, psychophysiological monitoring, health-oriented questionnaires),
each 15 minutes face-to-face with the patient; initial assessment.
96151 - Re-assessment
96152 - Health and behavior intervention, each 15 minutes, face-to-face; individual
96153 - Group (two or more patients)
96154 - Family (with the patient present)
96155 - Family (without the patient present)
320-11
CHAPTER 300
MEDICAL POLICY FOR AHCCCS COVERED SERVICES
POLICY 320
SERVICES WITH SPECIAL CIRCUMSTANCES
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
AHCCCS MEDICAL POLICY MANUAL
The following professionals are approved by AHCCCS to provide health and behavioral
assessments/interventions:
1. Psychologist
2. Licensed clinical social worker
3. Licensed marriage and family therapist
4. Licensed professional counselor, and
5. Psychiatric nurse practitioner
Health and behavior intervention services may be performed in the following places of
service:
1. Federally Qualified Health Clinic (FQHC)
2. Rural Health Clinic
3. Provider Office
4. The member‘s home
5. Indian Health Service (IHS) Freestanding Facility
6. IHS Provider Based Facility
7. Tribal 638 Freestanding Facility, and
8. Tribal 638 Provider Based Facility.
9. Integrated Behavioral Health Residential Facility
LIMITATIONS
1. Services are limited to 48 units annually (unit is equal to 15 minutes).
Members with mental health treatment needs exceeding the scope or duration of
services described (which are medical codes for behavioral health interventions)
should be appropriately referred for behavioral health services that will require
the specific use of behavioral health codes.
2. Services are limited to the providers and settings listed above.
