CPT code 96156: Health behavior assessment, assessment or reassessment2026 Medicare rate & RVUs in Missouri
Report 96156 for a health-focused assessment of behavioral factors affecting a patient's physical condition, treatment adherence, or health outcomes.
Medicare pays $103.85–$106.27 for 96156 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 96156 covers
96156 covers a health-focused clinical interview, behavioral observations, and clinical decision-making to assess how a patient's behavior and other personal factors relate to physical health. Physicians and other qualified health professionals may perform it in settings such as primary care or specialty clinics for patients managing conditions such as diabetes, chronic pain, or obesity. The focus is the connection between behavior and physical health, rather than psychotherapy or psychological testing.
Choose the code when the encounter consists of assessment or reassessment, not active behavioral intervention. Document the health condition or concern, relevant behavioral factors, assessment findings, and resulting clinical decisions. The service is not selected in timed increments; elapsed minutes alone do not establish additional units. CMS assigns physician work and practice-expense relative values, with practice-expense inputs differing between office and facility settings.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 96156 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$103.85 to $106.27
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $105.91 | $86.46 |
| Metropolitan St. Louis, MO | $106.27 | $86.56 |
| Rest of Missouri | $103.85 | $86.00 |
How the 96156 rate is calculated
Each of 96156’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 96156
RVUs × geographic indexes × conversion factor
Work2.40
2.40 RVUs× 1.000 GPCI
Practice expense0.80
0.80 RVUs× 1.000 GPCI
Malpractice0.02
0.02 RVUs× 1.000 GPCI
Adjusted RVUs
3.2200
Conversion factor
$33.4009
Medicare rate
$107.55
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 96156
96156 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 96156
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$107.55
- Non-facility (office)
- $107.55
- Facility
- $86.84
Higher because the practice carries its own overhead.
96156 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 96158Health behaviorIndividual, initial 30 minutes
- 96156 assesses behavioral factors affecting physical health; 96158 reports individual intervention addressing health behavior.
- 96127Behavioral screening toolPer scored standardized instrument
- 96127 is for a brief emotional or behavioral assessment. 96156 describes a health-focused assessment or reassessment tied to physical health.
- 96160Health risk assessmentPatient-focused instrument
- 96160 is a patient-focused health risk assessment; 96156 involves clinical assessment of behavior in relation to a health condition or concern.
- 96130Psychological evaluationFirst hour
- 96130 reports psychological test evaluation, including interpretation and clinical integration. 96156 is a health behavior assessment, not psychological test evaluation.
96156 billing questions
How is 96156 different from 96158?
96156 represents assessment or reassessment of behavioral factors affecting physical health. 96158 represents individual health behavior intervention, such as working with the patient on behavioral changes.
Can 96156 be billed in timed units?
No timed increments are specified for 96156. Document the assessment performed rather than deriving units from elapsed minutes.
What should the record support?
Document the physical health concern, the behavioral factors assessed, relevant observations or interview findings, and the clinical decisions resulting from the assessment.
When is 96127 a better fit?
Use 96127 for a brief emotional or behavioral assessment. Use 96156 when the service is a broader health-focused assessment of behavioral factors related to physical health.
Is a patient health-risk questionnaire the same service?
No. 96160 represents a patient-focused health risk assessment; 96156 involves health-focused clinical interviewing, behavioral observation, and clinical decision-making.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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