CPT 96165 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 96165 by major payers:
$5.95
$4.42
$5.87
$15.24
| 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 96165 | ||||||
United | 96165 | $16.82 | 1134437353 - ANDREA GRESETH | 363261413 - ALLINA HEALTH SYSTEM | MN | Neonatal Nurse Practitioner (363LN0000X) |
United | 96165 | $16.82 | 1336405711 - STEPHANIE SEASLY | 363261413 - ALLINA HEALTH SYSTEM | NY | Addiction Medicine (Family Medicine) Physician (207QA0401X) |
United | 96165 | $16.82 | 1164463832 - MARK EVANS | 363261413 - ALLINA HEALTH SYSTEM | MN | Cardiovascular Disease Physician (207RC0000X) |
United | 96165 | $16.82 | 1942599543 - ALINA WICK | 363261413 - ALLINA HEALTH SYSTEM | MN | Internal Medicine Physician (207R00000X) |
United | 96165 | $16.82 | 1285963793 - DIMITRIOS GIANNAKIDIS | 363261413 - ALLINA HEALTH SYSTEM | MN | Vascular Neurology Physician (2084V0102X) |
United | 96165 | $16.82 | 1376818757 - TAPAN THACKER | 363261413 - ALLINA HEALTH SYSTEM | MN | Neurology Physician (2084N0400X) |
United | 96165 | $16.82 | 1952858136 - ELLEN STOLL | 363261413 - ALLINA HEALTH SYSTEM | MN | Neonatal Nurse Practitioner (363LN0000X) |
United | 96165 | $16.82 | 1487889929 - BRITA WEGENER | 363261413 - ALLINA HEALTH SYSTEM | MN | Medical Physician Assistant (363AM0700X) |
United | 96165 | $16.82 | 1689077877 - MICHAEL FITZGERALD | 363261413 - ALLINA HEALTH SYSTEM | MN | Emergency Medicine Physician (207P00000X) |
United | 96165 | $12.76 | 1043861438 - SHERIFAT FORCEY | 363261413 - ALLINA HEALTH SYSTEM | TN | Psychiatric/Mental Health Nurse Practitioner (363LP0808X) |
United | 96165 | $16.82 | 1942072707 - BROOKE RODY | 363261413 - ALLINA HEALTH SYSTEM | MN | Midwife (176B00000X) |
United | 96165 | $16.82 | 1316090301 - WILLIAM PUHL | 363261413 - ALLINA HEALTH SYSTEM | MN | Certified Registered Nurse Anesthetist (367500000X) |
United | 96165 | $16.82 | 1770849937 - KATIE FREEMAN | 363261413 - ALLINA HEALTH SYSTEM | MN | Orthopaedic Surgery Physician (207X00000X) |
United | 96165 | $16.82 | 1508420902 - HANNAH SAYNER | 363261413 - ALLINA HEALTH SYSTEM | ME | Physician Assistant (363A00000X) |
United | 96165 | $16.82 | 1639130149 - MICHAEL CUMMINGS | 363261413 - ALLINA HEALTH SYSTEM | MN | Internal Medicine Physician (207R00000X) |
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 96165 vs. Other Health Behavior Assessment and Intervention Procedures Codes
The CPT 96165 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 96165 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 |
|---|---|---|
| 96165-CPT | Low | Level 4 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 |
| 96167-CPT | Low | Level 5 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 |
| 96168-CPT | Low | Initial Physician Evaluation And Management Of A Diabetic Patient With Diabetic Sensory Neuropathy Resulting In A Loss Of Protective Sensation (Lops) Which Must Include: (1) The Diagnosis Of Lops, (2) A Patient History, (3) A Physical Examination That Consists Of At Least The Following Elements: (A) Visual Inspection Of The Forefoot, Hindfoot, And Toe Web Spaces, (B) Evaluation Of A Protective Sensation, (C) Evaluation Of Foot Structure And Biomechanics, (D) Evaluation Of Vascular Status And Ski |
| 96170-CPT | Low | Follow-Up Physician Evaluation And Management Of A Diabetic Patient With Diabetic Sensory Neuropathy Resulting In A Loss Of Protective Sensation (Lops) To Include At Least The Following: (1) A Patient History, (2) A Physical Examination That Includes: (A) Visual Inspection Of The Forefoot, Hindfoot, And Toe Web Spaces, (B) Evaluation Of Protective Sensation, (C) Evaluation Of Foot Structure And Biomechanics, (D) Evaluation Of Vascular Status And Skin Integrity, And (E) Evaluation And Recommendat |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96165. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96165 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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