CPT Code 96167: Health behavior intervention, family with patient, group, first 30 min

When to Use CPT 96167

Use CPT code 96167 when billing for health behavior intervention, family with patient, group, first 30 min. This code is used by licensed therapists (LCSW, LPC, MFT, Psychologist) for outpatient sessions.

Adding CPT 96167 to a Superbill

When generating a superbill with CPT 96167, include the ICD-10 diagnosis code, date of service, fee charged, amount paid, and your NPI number. Superbilled pre-fills common therapy CPT codes automatically.

Common ICD-10 Pairings

These diagnosis codes are frequently used alongside CPT 96167:

Documentation Requirements

Document patient presence, family participation, group size, and how the session targets behavioral factors of each patient medical condition.

Common Denial Reasons

• ✗ Patient not present for one or more families — mixed coding needed
• ✗ Not linked to a medical diagnosis for each participant
• ✗ Group format not adequately documented

Reimbursement Expectations

OON reimbursement typically 35-55% of UCR. Expect $14-$44 per patient.