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See a sample rate comparisonCPT 96159 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Level 2 Hospital Emergency Department Visit Provided In A Type B Emergency Department; (The Ed Must Meet At Least One Of The Following Requirements: (1) It Is Licensed By The State In Which It Is Located Under Applicable State Law As An Emergency Room Or Emergency Department; (2) It Is Held Out To The Public (By Name, Posted Signs, Advertising, Or Other Means) As A Place That Provides Care For Emergency Medical Conditions On An Urgent Basis Without Requiring A Previously Scheduled Appointment; O
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Health Behavior Assessment and Intervention Procedures |
| Common Place of Service | 11 - Office |
| Common Modifiers | EP - Residential facility to Physician's office 95 - Telemedicine - audio and video |
| Complexity Level | Low |
| Medicare Fee Schedule | $25.39 national non-facility rate (2026) · View Medicare rates for 96159 |
| Medicaid Fee Schedule | $21.03 median of the 8 states in the free preview · View Medicaid rates for 96159 |
National average reimbursement for CPT 96159 by major payers:
$28.54
$22.32
$29.72
$42.36
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CPT 96159
5 of 25 sample ratesHigher to lower in this preview
Matthew Lilley
The Orthopedic And Neurosurgical Center Of The Cascades
$56.23Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$29.13Published rateSteven Sharp
Center For Family Guidance, PC
$23.48Published rateSteven Meek
Sarah Bush Lincoln Health Center
$22.37Published rateE And A Medical On The Go Healthcare Of South Florida LLC, E And A Healthcare On The Go
E And A Medical On The Go Healthcare Of South Florida LLC
$15.89Published rate
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See a sample payer proposalCPT 96159 vs. Other Health Behavior Assessment and Intervention Procedures Codes
The CPT 96159 code is part of the Medicine Services and Procedures services used for Health Behavior Assessment and Intervention Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 96159 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 96156-CPT | Low | Physician Supervision Of A Patient Under A Medicare-Approved Hospice (Patient Not Present) Requiring Complex And Multidisciplinary Care Modalities Involving Regular Physician Development And/Or Revision Of Care Plans, Review Of Subsequent Reports Of Patient Status, Review Of Laboratory And Other Studies, Communication (Including Telephone Calls) With Other Health Care Professionals Involved In The Patient's Care, Integration Of New Information Into The Medical Treatment Plan And/Or Adjustment Of |
| 96158-CPT | Low | Level 1 Hospital Emergency Department Visit Provided In A Type B Emergency Department; (The Ed Must Meet At Least One Of The Following Requirements: (1) It Is Licensed By The State In Which It Is Located Under Applicable State Law As An Emergency Room Or Emergency Department; (2) It Is Held Out To The Public (By Name, Posted Signs, Advertising, Or Other Means) As A Place That Provides Care For Emergency Medical Conditions On An Urgent Basis Without Requiring A Previously Scheduled Appointment; O |
| 96159-CPT | Low | Level 2 Hospital Emergency Department Visit Provided In A Type B Emergency Department; (The Ed Must Meet At Least One Of The Following Requirements: (1) It Is Licensed By The State In Which It Is Located Under Applicable State Law As An Emergency Room Or Emergency Department; (2) It Is Held Out To The Public (By Name, Posted Signs, Advertising, Or Other Means) As A Place That Provides Care For Emergency Medical Conditions On An Urgent Basis Without Requiring A Previously Scheduled Appointment; O |
| 96160-CPT | Low | Administration Of Patient-Focu, Administration Of Patient-Focused Health Risk Assessment Instrument (Eg Health Hazard Appraisal) With Scoring And Documentation Per Standardized Instrument |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96159. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96159 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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