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See a sample rate comparisonCPT 96203 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.
Mlt Fam Grp Bhv Train Ea Add, Multiple Family Group Behavior Management Modification Training For Parent S Guardian S Caregiver S Of Patients With A Mental Or Physical Health Diagnosis Administered By Physician Or Other Qualified Health Care Professional Without The Patient Present Face To Face With Multiple Sets Of Parent S Guardian S Caregiver S Each Additional 15 Minutes List Separately In Addition To Code For Primary Service
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Behavior Management Services |
| Common Place of Service | 19 - Off Campus Outpatient Hospital 11 - Office |
| Common Modifiers | 95 - Telemedicine - audio and video PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
| Medicare Fee Schedule | $5.34 national non-facility rate (2026) · View Medicare rates for 96203 |
| Medicaid Fee Schedule | $5.11 median of the 7 states in the free preview · View Medicaid rates for 96203 |
National average reimbursement for CPT 96203 by major payers:
$7.72
$6.05
$6.43
$20.51
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CPT 96203
5 of 25 sample ratesHigher to lower in this preview
John Mcmillin
Advocate Health And Hospitals Corporation
$13.50Published rateSandeep Gaonkar
Conventions Psychiatry Counseling PC
$8.09Published rateKarlene Goodman
$6.40Published rateAqeel Khan
Oxford Integrated Health Solutions PLLC
$6.09Published rateKristin Rosseau
Chicago Bh Hospital LLC
$4.80Published rate
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See a sample payer proposalCPT 96203 vs. Other Behavior Management Services Codes
The CPT 96203 code is part of the Medicine Services and Procedures services used for Behavior Management Services. 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 96203 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 |
| 96202-CPT | Low | Mlt Fam Grp Bhv Train 1st 60, Multiple Family Group Behavior Management Modification Training For Parent S Guardian S Caregiver S Of Patients With A Mental Or Physical Health Diagnosis Administered By Physician Or Other Qualified Health Care Professional Without The Patient Present Face To Face With Multiple Sets Of Parent S Guardian S Caregiver S Initial 60 Minutes |
| 96203-CPT | Low | Mlt Fam Grp Bhv Train Ea Add, Multiple Family Group Behavior Management Modification Training For Parent S Guardian S Caregiver S Of Patients With A Mental Or Physical Health Diagnosis Administered By Physician Or Other Qualified Health Care Professional Without The Patient Present Face To Face With Multiple Sets Of Parent S Guardian S Caregiver S Each Additional 15 Minutes List Separately In Addition To Code For Primary Service |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96203. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96203 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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