CPT 96161 Fee Schedule

Last Verified: January 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 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	• None • 59 - Distinct Procedural Service • EP - Residential facility to Physician's office
Complexity Level	Low

National average reimbursement for CPT 96161 by major payers:

$4.74

$4.52

$8.00

$14.35

Preview provider-level rates for...

For billing codeCPT 96161

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 96161
United	96161	$4.88	1881918415 - TUSHAR ADVANI	910844563	IL	Psychiatry Physician (2084P0800X)
United	96161	$4.53	1225318181 - SARTHAK MISRA	911780160	IL	Psychiatry Physician (2084P0800X)
United	96161	$3.14	1104993161 - BETH LEDVORA	463010946 - (IL) BETH LEDVORA M.D., S.C.	IL	Psychiatry Physician (2084P0800X)
United	96161	$5.11	1356397210 - M SHEIKH	362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION	IL	Psychiatry Physician (2084P0800X)
United	96161	$5.11	1679739148 - THANH THAI	366006541 - (IL) VETERANS ASSISTANCE COMMISSION C	IL	Psychiatry Physician (2084P0800X)
United	96161	$5.01	1942650130 - MALIK NASSAN	362679194 - (IL) HEAD & NECK AND COSMETIC SURGERY ASSOCIATES, LLC	IL	Psychiatry Physician (2084P0800X)
United	96161	$4.73	1033347125 - DAVID HANRAHAN	364015560 - LOYOLA UNIVERSITY MEDICAL CENTER	CA	Psychiatry Physician (2084P0800X)
United	96161	$3.92	1366890857 - STEVEN SHARP	364015560 - LOYOLA UNIVERSITY MEDICAL CENTER	OK	Psychiatry Physician (2084P0800X)
United	96161	$3.92	1740201425 - JOSEPH DIVINCENZO	364015560 - LOYOLA UNIVERSITY MEDICAL CENTER	PA	Psychiatry Physician (2084P0800X)
United	96161	$4.65	1962664789 - JAMIE EVANS	364015560 - LOYOLA UNIVERSITY MEDICAL CENTER	WI	Psychiatry Physician (2084P0800X)
United	96161	$9.56	1508192048 - DIANA SIECIECHOWICZ	363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN	IL	Neurology with Special Qualifications in Child Neurology Physician (2084N0402X)
United	96161	$4.63	1588222566 - NICHOLAS SAHAGIAN	452668894 - HEART CENTERED COUNSELING INC	IL	Psychiatry Physician (2084P0800X)
United	96161	$10.78	1508922964 - COLLEEN BUHRFIEND	363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN	IL	Neurology with Special Qualifications in Child Neurology Physician (2084N0402X)
United	96161	$10.78	1013173699 - REBECCA O'DONNELL	364187449	IL	Child & Adolescent Psychiatry Physician (2084P0804X)
United	96161	$3.61	1356608988 - TRIXIE LIPKE	391157876 - BEAVER DAM COMMUNITY HOSPITALS INC	WI	Psychiatry Physician (2084P0800X)
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

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CPT 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	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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