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See a sample rate comparisonHCPCS T1016 Fee Schedule
Last Verified: September 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.
Case management, each 15 minutes
| 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 |
| Medicaid Fee Schedule | View Medicaid rates for T1016 |
National average reimbursement for HCPCS T1016 by major payers:
$64.42
$12.64
$15.69
$12.17
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HCPCS T1016
5 of 25 sample ratesHigher to lower in this preview
Christine Wolfe
$15.43Published rateNabil Karroum
Main Line Healthcare
$14.60Published rateVikas Mandadi
Hln Physicians Inc
$10.00Published rateMary Grace Walsh
Scranton Counseling Center
$10.00Published rateKidspeace National Centers Inc
$10.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS 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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