CPT 96164 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 • 57 - Non-residential Substance Abuse Treatment Facility • 99 - Other POS |
| Common Modifiers | • None • HF • U2 |
| Complexity Level | Low |
National average reimbursement for CPT 96164 by major payers:
$12.45
$9.68
$12.63
$23.53
| 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 96164 | ||||||
United | 96164 | $8.72 | 1649932617 - LADAWNTA HYLTON | 852938829 | WA | Clinical Social Worker (1041C0700X) |
United | 96164 | $7.73 | 1548519291 - GARY WATERS | 931881269 | WA | Clinical Social Worker (1041C0700X) |
United | 96164 | $10.31 | 1316371859 - DAYLEN GONZALES | 862493019 | WA | Clinical Social Worker (1041C0700X) |
United | 96164 | $7.73 | 1568974269 - STEFFANEE HOLT | 852331121 | WA | Clinical Social Worker (1041C0700X) |
United | 96164 | $7.73 | 1497114631 - HOLLY MEGINNISS | 1467923953 | WA | Clinical Social Worker (1041C0700X) |
United | 96164 | $8.89 | 1164704979 - MARGARET PATTERSON | 911352172 | WA | Clinical Social Worker (1041C0700X) |
United | 96164 | $13.86 | 1477931830 - MICHAEL LIGHT | 911631806 | WA | Clinical Social Worker (1041C0700X) |
United | 96164 | $7.36 | 1619375789 - CARLA CLYDE | 916064184 | WA | Clinical Social Worker (1041C0700X) |
United | 96164 | $9.82 | 1174197081 - BRINA CARRIGAN | 883162646 | WA | Clinical Social Worker (1041C0700X) |
United | 96164 | $10.31 | 1376324616 - BRENNA BOWSER | 475025949 | WA | Clinical Social Worker (1041C0700X) |
United | 96164 | $10.22 | 1538359179 - CHARLENE KALLUSCH | 871927518 | WA | Psychologist (103T00000X) |
United | 96164 | $7.36 | 1588997043 - HEIDI GIBSON | 920986068 | WA | Clinical Social Worker (1041C0700X) |
United | 96164 | $7.36 | 1124415237 - DAWN SHEPHERD | 473737308 | WA | Clinical Social Worker (1041C0700X) |
United | 96164 | $20.22 | 1174097901 - ANNA AUSTING | 911631806 | WA | Clinical Social Worker (1041C0700X) |
United | 96164 | $7.73 | 1093209413 - AMY NIELSON | 831755703 | WA | Clinical Social Worker (1041C0700X) |
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 96164 vs. Other Health Behavior Assessment and Intervention Procedures Codes
The CPT 96164 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 96164 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 |
| 96164-CPT | Low | Level 3 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 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96164. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96164 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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