Medicare allows clinical social workers to bill the health behavior assessment and intervention codes, 96156 through 96171, which address the behavioral and psychological factors in a physical health condition. CMS opened them to CSWs starting with its 2024 physician fee schedule. State scope of practice, contractor policies and an independent clinical license in the patient's state still apply.
A patient with new type 2 diabetes who cannot stick to a medication schedule. A cardiac patient whose fear of exertion is stalling rehab. A cancer patient whose pain flares with anxiety. Much of what social workers do in medical settings is about how behavior and emotion shape a physical illness. The psychotherapy codes describe that work poorly. The health behavior assessment and intervention (HBAI) codes were built for it.
What changed
For years the HBAI codes were billed mainly by clinical psychologists. CMS opened them to clinical social workers, along with MFTs and mental health counselors, starting with its 2024 physician fee schedule. CMS's current Medicare & Mental Health Coverage booklet (MLN1986542, March 2026) states it plainly: CMS allows clinical psychologists, CSWs, MFTs and MHCs to bill the HBAI services and any successor codes.
The codes in that family are:
- 96156: health behavior assessment or re-assessment;
- 96158, 96159: individual intervention, initial 30 minutes and each additional 15;
- 96164, 96165: group intervention;
- 96167, 96168: family intervention with the patient present; and
- 96170, 96171: family intervention without the patient present.
The same booklet lists them as current Medicare telehealth codes. It also flags two newer HCPCS codes CSWs can bill: G0136 (a standardized physical activity and nutrition assessment, which can be furnished with an HBAI service) and G0560 (safety planning interventions).
Where this fits in integrated care
HBAI is useful anywhere a social worker is embedded with medical providers:
- primary care practices treating diabetes, hypertension, obesity or chronic pain;
- cardiology and pulmonary rehab programs;
- oncology and palliative care; and
- transplant, bariatric and dialysis-adjacent clinics (keeping in mind the separate facility exclusions).
Before you build a workflow around them, check three things. First, your state's scope of practice: Medicare covers what a CSW is legally authorized to do in the state where the patient is. Second, your Medicare Administrative Contractor's local policies and documentation expectations. Third, commercial payers, which set their own rules and may not follow CMS. Code descriptors themselves come from CPT, so use the current AMA definitions for time and documentation.
The license still comes first
None of this applies until the clinician is a CSW in Medicare's terms: an independent clinical license in the patient's state and an enrollment that covers that state. Integrated care practices that hire across a metro area that crosses state lines often find that gap first. Our state license services and the LMSW-to-LCSW Clinical License Upgrade close it; enrollment runs through our sister site, White Glove Credentialing.
Common questions
- Can an LCSW bill 96156 to Medicare?
- Yes. CMS's Medicare & Mental Health Coverage booklet says clinical psychologists, clinical social workers, MFTs and mental health counselors can bill the HBAI codes, including 96156.
- Can HBAI services be done by telehealth?
- CMS lists the HBAI codes as current Medicare telehealth codes. The clinician still needs a license in the state where the patient is located.
- Do commercial insurers pay social workers for HBAI codes?
- It depends on the payer and the contract. Commercial plans set their own rules and do not have to follow Medicare, so check each payer before billing.
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