HCPCS T1016 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 | • National Codes Established for State Medicaid Agencies • Other Services |
| Common Place of Service | • 53 - Community Mental Health Center • 99 - Other POS • 11 - Office |
| Complexity Level | Low |
National average reimbursement for HCPCS T1016 by major payers:
$64.42
$12.64
$15.69
$12.17
| 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 HCPCS T1016 | ||||||
United | T1016 | $13.89 | 1083035729 - BRENDA MANOHARAN | 381368360 - PINE REST CHRISTIAN MENTAL HEALTH SERVICES | PA | Psychiatry Physician (2084P0800X) |
United | T1016 | $10.00 | 1912454984 - WILLIAM THOMPSON | 300827397 - (PA) BELMONT BEHAVIORAL HOSPITAL LLC | PA | Clinical Social Worker (1041C0700X) |
United | T1016 | $10.00 | 1326031022 - WHITE DEER RUN, LLC, WHITE DEER RUN - ALLENWOOD | 223168733 | PA | Community/Behavioral Health Agency (251S00000X) |
United | T1016 | $10.00 | 1578050183 - RAVNEET KAUR | 820653875 - (PA) WESLEY FAMILY SERVICES | PA | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | T1016 | $14.60 | 1730263617 - MARK ALTER | 232359401 - MAIN LINE HEALTHCARE | PA | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | T1016 | $14.60 | 1740201425 - JOSEPH DIVINCENZO | 232359401 - MAIN LINE HEALTHCARE | PA | Psychiatry Physician (2084P0800X) |
United | T1016 | $10.00 | 1720540651 - COREY DORSEY | 232799679 - MERAKEY PENNSYLVANIA | PA | Counselor (101Y00000X) |
United | T1016 | $10.00 | 1871960930 - ABDELRAHMAN ABDELAZIZ | 232205138 - (PA) FOLIUM INC | MI | Psychiatry Physician (2084P0800X) |
United | T1016 | $10.00 | 1164601548 - CHIJIOKE EGBUJO | 200085660 - (PA) BHC NORTHWEST PSYCHIATRIC HOSPITAL LLC | CT | Psychiatry Physician (2084P0800X) |
United | T1016 | $10.30 | 1730263617 - MARK ALTER | 390808509 - THE MONROE CLINIC INC | CA | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | T1016 | $14.60 | 1184156580 - CALEB WASHABAUGH | 232215243 - (PA) MIRMONT ALCOHOL REHABILITATION CENTER | PA | Psychiatry Physician (2084P0800X) |
United | T1016 | $15.43 | 1245625318 - RAHEELA SULTAN | 233027382 | MD | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | T1016 | $10.00 | 1184940389 - MIRIAM HARTNER | 250965612 - EXCELA HEALTH | PA | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | T1016 | $14.60 | 1750719928 - MEGHAN RICHETTI | 232359401 - MAIN LINE HEALTHCARE | PA | Clinical Psychologist (103TC0700X) |
United | T1016 | $10.00 | 1821237868 - JOSETTE GRADY | 232835448 | PA | 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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HCPCS T1016 vs. Other Other Services Codes
The HCPCS T1016 code is part of the National Codes Established for State Medicaid Agencies services used for Other 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 HCPCS T1016 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 |
|---|---|---|
| T1015-HCPCS | Low | Clinic visit/encounter, all-inclusive |
| T1016-HCPCS | Low | Case management, each 15 minutes |
| T1017-HCPCS | Low | Targeted case management, each 15 minutes |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS T1016. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the T1016 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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