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See a sample rate comparisonCPT 96161 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.
Caregiver Health Risk Assmt, Administration Of Caregiver Focused Health Risk Assessment Instrument Eg Depression Inventory For The Benefit Of The Patient 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 99 - Other POS |
| Common Modifiers | 59 - Distinct Procedural Service EP - Residential facility to Physician's office |
| Complexity Level | Low |
| Medicare Fee Schedule | $3.34 national non-facility rate (2026) · View Medicare rates for 96161 |
| Medicaid Fee Schedule | $3.16 median of the 8 states in the free preview · View Medicaid rates for 96161 |
National average reimbursement for CPT 96161 by major payers:
$4.74
$4.52
$8.00
$14.42
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CPT 96161
5 of 25 sample ratesHigher to lower in this preview
Colleen Buhrfiend
Pediatric Faculty Foundation In
$10.78Published rateJenifer Lloyd
The Board Of Trustees Of The University Of Illinois
$6.88Published rateTushar Advani
$4.88Published rateSarthak Misra
$4.53Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$1.97Published rate
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See a sample payer proposalCPT 96161 vs. Other Health Behavior Assessment and Intervention Procedures Codes
The CPT 96161 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 96161 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 |
| 96161-CPT | Low | Caregiver Health Risk Assmt, Administration Of Caregiver Focused Health Risk Assessment Instrument Eg Depression Inventory For The Benefit Of The Patient 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 96161. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96161 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
Healthcare costs can vary significantly based on the provider, location, and your insurance plan. To get an estimate for a specific medical procedure or service, you can use Payerprice's fee schedule lookup tool. It allows you to search for costs using CPT codes and your specific location, providing transparency before you receive care. It's also advisable to contact your insurance provider to understand your coverage and potential out-of-pocket costs.
For detailed fee schedules and pricing information linked to specific CPT (Current Procedural Terminology) codes, you can utilize Payerprice. They offer a fee schedule lookup tool that allows you to search by CPT code and specific location, providing insights into the costs of various medical services.
Comparing healthcare prices can be complex due to varying provider charges and insurance negotiated rates. However, to get a better understanding of the typical costs for specific services, you can use Payerprice. Their fee schedule lookup tool allows you to search by CPT code and location, giving you data that can help you compare potential expenses across different providers in your area before making a decision. Always confirm final costs with your chosen provider and insurance.
If you don't understand an item on your medical bill, the first step is to contact the billing department of the healthcare provider directly for clarification. Ask them to explain each charge and the associated CPT codes. You can then use Payerprice to look up the typical fee schedule for those CPT codes in your area, which can help you understand if the charges are in line with local averages. Also, compare the bill with your Explanation of Benefits (EOB) from your insurance company.
To determine if your insurance covers a specific medical procedure and your exact out-of-pocket cost, you should directly contact your insurance provider. They can inform you about your coverage, deductibles, co-pays, and co-insurance. For an understanding of the typical costs of the procedure itself, which can help you estimate your portion, you can use Payerprice's fee schedule lookup tool with the relevant CPT code and your location. This information, combined with your insurance details, will give you a clearer picture.