CPT 96160 Fee Schedule
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.
| 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 | • None • 59 - Distinct Procedural Service • EP - Residential facility to Physician's office |
| Complexity Level | Low |
National average reimbursement for CPT 96160 by major payers:
$4.72
$4.53
$8.05
$14.35
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 96160 | ||||||
United | 96160 | $4.50 | 1114924321 - THOMAS WOOL | 630691533 - (AL) MONTGOMERY CARDIOVASCULAR ASSOCIATES, P.C. | AL | Interventional Cardiology Physician (207RI0011X) |
United | 96160 | $2.60 | 1225355514 - JOSHUA TURNER | 631119002 - (AL) BIRMINGHAM HEART CLINIC, PC | AL | Interventional Cardiology Physician (207RI0011X) |
United | 96160 | $3.03 | 1851400485 - GEORGE HEMSTREET | 636000271 - (AL) THE DCH HEALTH CARE AUTHORITY | AL | Interventional Cardiology Physician (207RI0011X) |
United | 96160 | $5.88 | 1912282948 - IMRAN KHALIL | 61330992 - NORTHEAST MEDICAL GROUP INC | AL | Interventional Cardiology Physician (207RI0011X) |
United | 96160 | $3.81 | 1326077058 - MICHAEL MANSOUR | 631012832 | AL | Interventional Cardiology Physician (207RI0011X) |
United | 96160 | $2.01 | 1851400485 - GEORGE HEMSTREET | 824122192 | AL | Interventional Cardiology Physician (207RI0011X) |
United | 96160 | $5.13 | 1497966287 - JAMES TOWERY | 621545731 - BAPTIST MEMORIAL MEDICAL GROUP INC | AL | Interventional Cardiology Physician (207RI0011X) |
United | 96160 | $2.01 | 1972537397 - DARRYL HAMILTON | 630047680 - (AL) COMMUNITY HOSPITAL INC | AL | Interventional Cardiology Physician (207RI0011X) |
United | 96160 | $7.63 | 1225412083 - AADIL LODHI | 440577118 - LESTER E COX MEDICAL CENTER | PA | Interventional Cardiology Physician (207RI0011X) |
United | 96160 | $2.25 | 1821208497 - ANAND MISHRA | 811585825 - (AL) ECM TVCC LLC | AL | Interventional Cardiology Physician (207RI0011X) |
United | 96160 | $2.63 | 1427019843 - MARK SASSE | 383976603 | AL | Interventional Cardiology Physician (207RI0011X) |
United | 96160 | $8.89 | 1760585574 - YABIZ SEDGHI | 823898488 | OH | Interventional Cardiology Physician (207RI0011X) |
United | 96160 | $4.28 | 1043266919 - ERIK EWAYS | 630889615 - (AL) CARDIOLOGY ASSOCIATES OF MOBILE, INC. | AL | Interventional Cardiology Physician (207RI0011X) |
United | 96160 | $2.77 | 1609937945 - HUNTSVILLE CARDIOVASCULAR CLINIC, P. C. | 631211664 - (AL) HUNTSVILLE CARDIOVASCULAR CLINIC, P.C. | AL | Interventional Cardiology Physician (207RI0011X) |
United | 96160 | $4.50 | 1174781017 - KEVIN DEANDRADE | 631159436 - (AL) MOBILE HEART SPECIALISTS, P.C. | AL | Interventional Cardiology Physician (207RI0011X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 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-Focused Health Risk Assessment Instrument (Eg Health Hazard Apprai- Sal) With Scoring And Documentation Per Standar- Dized 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 96160) and we'll show you how you compare in 15 minutes or less.