CPT Code Overview

CPT 0364T denotes behavior treatment services provided in the field of Gastroenterology. This code is used to report structured interventions focused on behavioral management related to gastrointestinal conditions. The typical site of service for CPT 0364T is Outpatient Hospital (POS 22).

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A middle-aged adult presents to an outpatient hospital gastroenterology clinic with rectal bleeding, anal pain, and change in bowel habits. The gastroenterology team performs a focused behavioral treatment visit related to anorectal disorders, addressing bowel toileting behaviors, defecation dynamics, biofeedback techniques, and toileting hygiene. The service is provided in an outpatient hospital (POS 22) setting after an initial diagnostic evaluation (which may have included anoscopy, sigmoidoscopy, or colonoscopy). The clinician documents baseline symptoms, prior interventions, education delivered, observed toileting mechanics, and a short-term treatment plan aimed at modifying defecation behavior. Time-based interactions and professional interpretation of behavioral findings may be included in the visit note.

Modifiers:

• 26: Professional Component — Use when reporting only the professional component of the service (physician interpretation and management) separated from facility or technical resources.

• TC: Technical Component — Use when reporting only the technical component of the service (facility, equipment, and non-physician personnel) separated from the professional component.

• 59: Distinct Procedural Service — Use when the behavioral treatment is a distinct service from other procedures performed on the same day and not normally billed together; supports separate billing when documentation shows a separate and distinct service.

Associated Provider Taxonomies:

• 207RG0100X: Gastroenterology Physician — Specialty providing diagnostic and therapeutic care for gastrointestinal and anorectal disorders.

• 208C00000X: Colon & Rectal Surgery Physician — Specialty focused on surgical and non-surgical management of anorectal and colorectal conditions.

• 207Q00000X: Family Medicine Physician — Primary care specialty that may provide behavioral management or coordinate referral to gastroenterology or colorectal surgery.

List of related ICD-10 codes:

• K62.89 — Other specified diseases of anus and rectum

  Clinical relevance: Represents non-specific anorectal conditions that may cause symptoms addressed by behavioral treatment, such as pain or functional disturbance.

• K62.5 — Hemorrhage of anus and rectum

  Clinical relevance: Rectal bleeding is a common presenting symptom that prompts anorectal evaluation; behavioral measures may be part of conservative management.

• D12.8 — Benign neoplasm of rectum

  Clinical relevance: Benign rectal lesions may cause bleeding or changes in defecation; behavioral treatment may be adjunctive to diagnostic or therapeutic procedures.

• K64.9 — Hemorrhoids, unspecified

  Clinical relevance: Hemorrhoidal disease commonly produces pain, bleeding, and defecatory difficulty; behavioral modification is often part of nonprocedural care.

• R19.5 — Other fecal abnormalities

  Clinical relevance: Symptoms such as stool incontinence, constipation, or abnormal stooling patterns can be targets for behavioral therapy and toileting retraining.

Related CPT codes:

• 46600 — Anoscopy; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)

  This diagnostic procedure may precede or accompany behavioral interventions to evaluate anorectal mucosa; billed separately when performed.

• 46606 — Anoscopy; with dilation (e.g., balloon, guide wire, bougie) (separate procedure)

  Therapeutic anoscopy with dilation may be an intervention for structural anorectal issues; considered a distinct procedure when behavioral treatment is also provided.

• 45330 — Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)

  Flexible sigmoidoscopy is a diagnostic alternative for distal colorectal evaluation; may be performed in the same episode of care and billed separately.

• 45378 — Colonoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure)

  Full colonoscopic evaluation is an alternative or adjunct diagnostic procedure for rectal bleeding or neoplasm assessment; commonly performed in the same patient but billed as a separate service.

Common combinations and workflow notes:

• Behavioral treatment (0364T) is commonly documented as a separate, non-overlapping service when diagnostic endoscopic procedures (46600, 46606, 45330, 45378) are performed during the same visit; use 59 when documentation supports a distinct procedural service.

• Use 26 and TC to split professional and technical components when the facility bills the technical resources separately from the physician's professional work.

National commercial averages are materially higher than the available Medicare-equivalent benchmark. BUCA (average commercial) and Cigna sit near $40.52 and $40.55 mean rates, respectively, while Blue Cross Blue Shield shows a substantially lower mean at $22.32. Medicare data is not available in the input.

Dispersion across payers is tight for BUCA and Cigna, each showing a small interquartile range (P75 − P25 ≈ $1.30 for BUCA and $1.20 for Cigna), indicating concentrated payment levels. Blue Cross Blue Shield displays no dispersion in the provided percentiles (P25 = P50 = P75 = $14.00), reflecting a compressed reported distribution. The table and chart below present the full breakdown.