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Changes to Early Intervention Service Code 96153

December 30, 2019

Effective January 1, 2020, CMS has proposed new changes to the existing CPT codes in the form of the 2020 Health Behavior Assessment and Intervention CPT Codes. Early Intervention (EI) providers will no longer bill using 96153 (to bill for EI child group).

96153-U1 and 96153-U2 - Health and Behavior Assessment (codes previously used to bill for EI child group) is being replaced by the following:

96164-U1: Health behavior intervention, group (2 or more patients), face-to-face, initial 30 minutes, (use for EI-only health behavior intervention group), (clinical justification required for EI services to be provided in an EI-only health behavior intervention group, rather than an EI community health behavior intervention group (96164-U2)), (services must be documented in the member's Individual Family Service Plan (IFSP) in accordance with Department of Public Health operational standards); (maximum 2 units per week allowed per child)

96165-U1: Health behavior intervention, group (2 or more patients), face-to-face, each additional 15 minutes following the initial 30 minute units in EI-only health behavior intervention group (96164-U1); (list separately in addition to code for primary service)(maximum 6 units per week per child)

96164-U2: Health behavior intervention, group (2 or more patients), face-to-face, initial 30 minutes, (use for EI community health behavior intervention group, including both children enrolled in EI and those not enrolled in EI); (maximum 2 units per week per member)

96165-U2: Health behavior intervention, group (2 or more patients), face-to-face, each additional 15 minutes following the initial 30 minute units in EI community health behavior intervention group (96164-U2), (list separately in addition to code for primary service); (maximum 6 units per week per child)

Providers must include the appropriate modifier with each service code when submitting claims. The Subchapter 6 of the Early Intervention Program Manual will be updated to reflect these changes.

If you have any questions, please contact the MassHealth Customer Service Center at (800) 841-2900 or e-mail providersupport@mahealth.net.