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See a sample rate comparisonCPT 96160 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.
Administration Of Patient-Focu, Administration Of Patient-Focused Health Risk Assessment Instrument (Eg Health Hazard Appraisal) With Scoring And Documentation Per Standardized Instrument
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Health Behavior Assessment and Intervention Procedures |
| Common Place of Service | 11 - Office 50 - Federally Qualified Health Center |
| Common Modifiers | 59 - Distinct Procedural Service EP - Residential facility to Physician's office |
| Complexity Level | Low |
| Medicare Fee Schedule | $3.01 national non-facility rate (2026) · View Medicare rates for 96160 |
| Medicaid Fee Schedule | $3.445 median of the 8 states in the free preview · View Medicaid rates for 96160 |
National average reimbursement for CPT 96160 by major payers:
$4.72
$4.53
$8.05
$14.99
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CPT 96160
5 of 25 sample ratesHigher to lower in this preview
Jody Whitelock
$6.88Published rateCelia Lenarz-Geisen
$6.88Published rateAmy Bailey
$4.50Published rateTraci Hess
$4.50Published rateGeorge Hemstreet
$2.01Published rate
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See a sample payer proposalCPT 96160 vs. Other Health Behavior Assessment and Intervention Procedures Codes
The CPT 96160 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 96160 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 96160. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96160 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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Frequently Asked Questions
To get specific pricing information for medical procedures based on CPT codes and your location, you should utilize Payerprice. Payerprice offers a fee schedule lookup tool designed to help users search for these costs, providing a more accurate estimate tailored to your situation.
CPT stands for Current Procedural Terminology. CPT codes are standardized medical codes used by physicians, hospitals, and other healthcare providers to describe the services and procedures they provide to patients. These codes are essential for billing, insurance claims, and tracking healthcare services.
A deductible is the amount you must pay for covered healthcare services before your insurance plan starts to pay. A copay (or copayment) is a fixed amount you pay for a covered healthcare service after your deductible has been met. Coinsurance is your share of the cost of a healthcare service, calculated as a percentage (e.g., 20%) of the allowed amount for the service, after you've met your deductible.
Medical costs can vary significantly due to numerous factors, including the healthcare provider's negotiated rates with insurance companies, the specific geographical location, the facility type (e.g., hospital vs. outpatient clinic), the complexity of the procedure, and the patient's individual insurance plan. For specific cost estimates based on CPT codes and your location, Payerprice's lookup tool can help clarify these variations.
Understanding medical bills can be complex. You should always review your Explanation of Benefits (EOB) from your insurance company and compare it to the bill from your provider. Check for correct dates of service, accurate CPT codes, and ensure that you're only being billed for services you received. If you have questions about specific CPT codes or expected costs, Payerprice can help you look up fee schedules to cross-reference prices.