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See a sample rate comparisonCPT 96171 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.
Bpci Home Visit (Bundled Payments For Care Improvement Initiative Home Visit For Patient Assessment Performed By A Qualified Health Care Professional For Individuals Not Considered Homebound Including, But Not Limited To, Assessment Of Safety, Falls, Clinical Status, Fluid Status, Medication Reconciliation/Management, Patient Compliance With Orders/Plan Of Care, Performance Of Activities Of Daily Living, Appropriateness Of Care Setting.) (For Use Only In The Medicare-Approved Bundled Payments Fo
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Health Behavior Assessment and Intervention Procedures |
| Common Place of Service | 11 - Office |
| Common Modifiers | EP - Residential facility to Physician's office GT - Via interactive audio and video telecommunication systems |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 96171 |
| Medicaid Fee Schedule | $22.99 median of the 8 states in the free preview · View Medicaid rates for 96171 |
National average reimbursement for CPT 96171 by major payers:
$37.21
$28.26
$36.13
$51.24
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CPT 96171
5 of 25 sample ratesHigher to lower in this preview
Lauren Schumacher
$185.14Published rateKaren Severson
Loyola University Medical Center
$58.63Published rateSharad Koirala
Mount Sinai Community Foundation
$37.68Published rateJohnathan Coleman
Uhs Of Hartgrove Inc
$28.47Published rateFrank Walch
$22.42Published rate
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See a sample payer proposalCPT 96171 vs. Other Health Behavior Assessment and Intervention Procedures Codes
The CPT 96171 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 96171 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 |
| 96171-CPT | Low | Bpci Home Visit (Bundled Payments For Care Improvement Initiative Home Visit For Patient Assessment Performed By A Qualified Health Care Professional For Individuals Not Considered Homebound Including, But Not Limited To, Assessment Of Safety, Falls, Clinical Status, Fluid Status, Medication Reconciliation/Management, Patient Compliance With Orders/Plan Of Care, Performance Of Activities Of Daily Living, Appropriateness Of Care Setting.) (For Use Only In The Medicare-Approved Bundled Payments Fo |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96171. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96171 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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