CPT code 96158: Health behavior, individual, initial 30 minutes2026 Medicare rate & RVUs in New Mexico

Report 96158 for an individual face-to-face intervention addressing behavioral or psychosocial factors that affect a patient’s physical health or medical treatment.

CMS RVU26DEffective Oct 1, 2026One payment locality31.9K Medicare services in 2024

In New Mexico, Medicare pays $72.39 for 96158 in the office and $59.52 when it’s performed in a hospital or facility.

$72.39Office (non-facility)

$59.52Hospital or facility

−1.9%vs the national office rate ($73.82)

Check a contract rate as a % of Medicare · 96158 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

On this page 11 sections

Rate in New Mexico
What 96158 covers
Compared with other areas
Rate map
How it’s calculated
Payment rules
Related codes
Rate history
Where it applies
Billing questions
Sources

What 96158 covers

A qualified health professional works face-to-face with one patient to change behaviors or address psychosocial factors affecting a physical health condition, its treatment, or recovery. Common situations include helping a patient with chronic pain use coping strategies, supporting adherence to a diabetes treatment plan, or addressing behavior changes related to cardiovascular disease. Psychologists, clinical social workers, and other qualified professionals may provide the service in primary care or specialty medical settings.

Report 96158 for the initial 30 minutes of individual intervention with the patient. The note should identify the health condition or treatment-related concern, the behavioral intervention provided, the patient’s participation, and the time spent. Use 96159 for qualifying additional time. CMS assigns work, practice expense, and malpractice relative values; the practice-expense value differs 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.

How New Mexico compares for 96158

Across 109 of 109 payment localities, the office rate for 96158 runs from $71.11 in Arkansas to $102.56 in Alaska. New Mexico pays $72.39. The RVUs are the same everywhere; the geographic indexes change the dollars.

96158 in New Mexico vs other payment areas

New Mexico · this page$72.39
Los Angeles, CA · California$79.28+$6.89
Washington, DC area · District of Columbia$80.06+$7.67
Miami, FL · Florida$75.07+$2.68
Chicago, IL · Illinois$74.73+$2.34
Manhattan, NY · New York$80.48+$8.09
Alaska · Alaska$102.56+$30.17

Other areas in New Mexico first, then benchmark localities. Bars start at $0.

Every other payment area

96158 in every other Medicare payment locality
Payment locality	Office	Facility
AlabamaAlabama	$71.42	$59.14
ArkansasArkansas	$71.11	$59.06
ArizonaArizona	$73.21	$59.62
Bakersfield, CACalifornia	$76.47	$61.10
Chico, CACalifornia	$76.34	$60.96
El Centro, CACalifornia	$76.34	$60.96
Fresno, CACalifornia	$76.34	$60.96
Hanford, CACalifornia	$76.34	$60.96
Madera, CACalifornia	$76.34	$60.96
Merced, CACalifornia	$76.34	$60.96
Modesto, CACalifornia	$76.34	$60.96
Napa, CACalifornia	$82.88	$64.39
Oxnard, CACalifornia	$78.53	$61.94
Redding, CACalifornia	$76.34	$60.96
Rest of CaliforniaCalifornia	$76.34	$60.96
Riverside, CACalifornia	$76.50	$61.12
Sacramento, CACalifornia	$78.60	$62.28
Salinas, CACalifornia	$78.25	$61.99
San Diego, CACalifornia	$78.86	$62.08
Marin County, CACalifornia	$86.30	$66.52
San Francisco, CACalifornia	$86.29	$66.51
San Benito County, CACalifornia	$87.73	$67.50
Santa Clara County, CACalifornia	$87.69	$67.46
San Luis Obispo, CACalifornia	$77.11	$61.13
Santa Cruz, CACalifornia	$78.70	$61.66
Santa Maria, CACalifornia	$78.21	$61.85
Santa Rosa, CACalifornia	$79.44	$62.21
Stockton, CACalifornia	$76.34	$60.96
Vallejo, CACalifornia	$82.86	$64.37
Visalia, CACalifornia	$76.34	$60.96
Yuba City, CACalifornia	$76.34	$60.96
ColoradoColorado	$75.56	$60.64
ConnecticutConnecticut	$76.38	$61.28
DelawareDelaware	$73.84	$59.98
Fort Lauderdale, FLFlorida	$74.32	$60.11
Rest of FloridaFlorida	$73.19	$59.78
Atlanta, GAGeorgia	$74.34	$60.09
Rest of GeorgiaGeorgia	$71.93	$59.42
Hawaii, Guam, HIHawaii	$76.15	$60.20
IowaIowa	$72.08	$59.25
IdahoIdaho	$72.20	$59.29
East St. Louis, ILIllinois	$72.71	$59.81
Rest of IllinoisIllinois	$72.43	$59.63
Suburban Chicago, ILIllinois	$74.95	$60.54
IndianaIndiana	$72.33	$59.32
KansasKansas	$71.92	$59.24
KentuckyKentucky	$71.79	$59.31
New Orleans, LALouisiana	$72.80	$59.60
Rest of LouisianaLouisiana	$71.73	$59.31
Metropolitan Boston, MAMassachusetts	$79.55	$62.80
Rest of MassachusettsMassachusetts	$75.59	$60.82
Baltimore area, MDMaryland	$76.10	$61.05
Rest of MarylandMaryland	$74.56	$60.36
Rest of MaineMaine	$72.25	$59.34
Southern Maine, MEMaine	$73.53	$59.63
Detroit, MIMichigan	$73.41	$59.88
Rest of MichiganMichigan	$72.29	$59.48
MinnesotaMinnesota	$74.10	$59.67
Metropolitan Kansas City, MOMissouri	$72.71	$59.54
Metropolitan St. Louis, MOMissouri	$72.95	$59.60
Rest of MissouriMissouri	$71.32	$59.23
MississippiMississippi	$71.22	$59.14
MontanaMontana	$73.82	$59.79
North CarolinaNorth Carolina	$72.49	$59.40
North DakotaNorth Dakota	$73.62	$59.59
NebraskaNebraska	$72.22	$59.27
New HampshireNew Hampshire	$74.51	$59.91
Northern New JerseyNew Jersey	$80.22	$63.94
Rest of New JerseyNew Jersey	$77.73	$62.41
NevadaNevada	$73.78	$59.74
NYC suburbs and Long Island, NYNew York	$81.06	$64.38
Poughkeepsie and northern NYC suburbs, NYNew York	$78.09	$62.73
Queens, NYNew York	$80.79	$64.21
Rest of New YorkNew York	$72.81	$59.49
OhioOhio	$72.25	$59.44
OklahomaOklahoma	$71.81	$59.28
Portland, OROregon	$76.62	$61.03
Rest of OregonOregon	$73.64	$59.67
Metropolitan Philadelphia, PAPennsylvania	$75.62	$61.01
Rest of PennsylvaniaPennsylvania	$72.32	$59.44
Puerto RicoPuerto Rico	$74.01	$59.83
Rhode IslandRhode Island	$75.43	$60.94
South CarolinaSouth Carolina	$72.40	$59.43
South DakotaSouth Dakota	$73.59	$59.57
TennesseeTennessee	$72.02	$59.27
Austin, TXTexas	$74.93	$60.09
Beaumont, TXTexas	$72.17	$59.40
Brazoria, TXTexas	$74.02	$60.12
Dallas, TXTexas	$74.20	$60.22
Fort Worth, TXTexas	$74.02	$60.19
Galveston, TXTexas	$74.08	$60.15
Houston, TXTexas	$74.26	$60.33
Rest of TexasTexas	$72.86	$59.55
UtahUtah	$72.70	$59.51
VirginiaVirginia	$73.41	$59.62
Virgin Islands, VIUnited States Virgin Islands	$74.01	$59.83
VermontVermont	$73.47	$59.58
Rest of WashingtonWashington	$75.41	$60.64
King County, WAWashington	$80.62	$63.41
WisconsinWisconsin	$72.83	$59.39
West VirginiaWest Virginia	$71.60	$59.41
WyomingWyoming	$73.73	$59.70

96158 rates by state

Office rate range in each state. Select a state to see its payment localities.

ME WI VT NH MT ND MN MI NY MA RI WA ID WY SD IA IL IN OH PA NJ CT OR NV UT CO NE MO KY WV VA MD DE CA AZ NM KS OK AR TN NC SC DC TX LA MS AL GA FL AK HI

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$71.11

$102.56

Color shows the midpoint of each state’s locality range.

View every state and territory as a table

96158 office rate range by state
State / territory	Office rate range	Localities
AK	$102.56	1
AL	$71.42	1
AR	$71.11	1
AZ	$73.21	1
CA	$76.34–$87.73	29
CO	$75.56	1
CT	$76.38	1
DC	$80.06	1
DE	$73.84	1
FL	$73.19–$75.07	3
GA	$71.93–$74.34	2
GU	$76.15	1
HI	$76.15	1
IA	$72.08	1
ID	$72.20	1
IL	$72.43–$74.95	4
IN	$72.33	1
KS	$71.92	1
KY	$71.79	1
LA	$71.73–$72.80	2
MA	$75.59–$79.55	2
MD	$74.56–$80.06	3
ME	$72.25–$73.53	2
MI	$72.29–$73.41	2
MN	$74.10	1
MO	$71.32–$72.95	3
MS	$71.22	1
MT	$73.82	1
NC	$72.49	1
ND	$73.62	1
NE	$72.22	1
NH	$74.51	1
NJ	$77.73–$80.22	2
NM	$72.39	1
NV	$73.78	1
NY	$72.81–$81.06	5
OH	$72.25	1
OK	$71.81	1
OR	$73.64–$76.62	2
PA	$72.32–$75.62	2
PR	$74.01	1
RI	$75.43	1
SC	$72.40	1
SD	$73.59	1
TN	$72.02	1
TX	$72.17–$74.93	8
UT	$72.70	1
VA	$73.41–$80.06	2
VI	$74.01	1
VT	$73.47	1
WA	$75.41–$80.62	2
WI	$72.83	1
WV	$71.60	1
WY	$73.73	1

See 96158 in every payment locality

How the 96158 rate is calculated

Each of 96158’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 · 96158

RVUs × geographic indexes × conversion factor

Office or facility?

Your ZIP

Work1.66

1.66 RVUs× 1.000 GPCI

Practice expense0.54

0.54 RVUs× 1.000 GPCI

Malpractice0.01

0.01 RVUs× 1.000 GPCI

Adjusted RVUs

2.2100

Conversion factor

$33.4009

Medicare rate

$73.82

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact New Mexico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

12,765

Code: 96158
Physician work: 1.66
Practice expense: 0.54
Malpractice: 0.01

GPCI2026.csv

Locality: New Mexico
Physician work: 1.000
Practice expense: 0.917
Malpractice: 1.201

Office calculation for 96158 in New Mexico
Component	RVU	Locality factor	Adjusted
Physician work	1.66	× 1.000	1.6600
Practice expense	0.54	× 0.917	0.4952
Malpractice	0.01	× 1.201	0.0120
Total RVUs			2.1672
Conversion factor			× 33.4009

Office rate, New Mexico$72.39

Office: (1.66 × 1 + 0.54 × 0.917 + 0.01 × 1.201) × $33.4009 = $72.39

Facility: (1.66 × 1 + 0.12 × 0.917 + 0.01 × 1.201) × $33.4009 = $59.52

Open 96158 in the RVU calculator

Payment rules and modifiers for 96158

96158 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 · 96158

Which rate does Medicare pay?

Place of service

The POS code on the claim line (CMS-1500 box 24B).

POS 11 · non-facility rate · national

$73.82

Non-facility (office): $73.82
Facility: $59.79

Higher because the practice carries its own overhead.

Codes related to 96158

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 96158
Code	How it relates	Office range, New Mexico
Add-on codes
96159	Health behavior intervention, individual, additional timeAdditional-time code reported with 96158 for qualifying continued individual intervention.	$24.86
Used instead
96164	Group intervention, first 30 minutesInitial-time code for health behavior intervention delivered in a group rather than individually.	$11.48
96167	Family intervention, patient present, initial 30 minutesInitial-time code for family intervention with the patient present.	$76.67
96170	Family intervention, patient absentInitial-time code for family intervention when the patient is not present.	No office rate

How 96158 has changed in New Mexico

96158 · Office / nonfacility

$72.39

Effective 2026-10-01

Compare with release effective

The base rate is $5.64 higher than on 2025-10-01, moving from $66.75 to $72.39 (8.4%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

January 1, 2026
RVU26A
$66.75changed to$72.39
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.59 changed to 1.66
- Practice expense RVU 0.47 changed to 0.54
- Malpractice RVU 0.04 changed to 0.01
- Practice expense GPCI 0.908 changed to 0.917
- Malpractice GPCI 1.172 changed to 1.201
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$65.76changed to$66.75
- Conversion factor 33.2875 changed to 32.3465
- Work RVU 1.52 changed to 1.59
- Practice expense RVU 0.45 changed to 0.47
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$64.69changed to$65.76
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$63.86changed to$64.69
- Conversion factor 33.8872 changed to 32.7442
- Work RVU 1.45 changed to 1.52
- Practice expense RVU 0.43 changed to 0.45
- Practice expense GPCI 0.902 changed to 0.908
- Malpractice GPCI 1.169 changed to 1.172
January 1, 2023
RVU23A
$66.03changed to$63.86
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 0.42 changed to 0.43
- Malpractice RVU 0.07 changed to 0.04
- Practice expense GPCI 0.896 changed to 0.902
- Malpractice GPCI 1.166 changed to 1.169
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$65.45changed to$66.03
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 0.41 changed to 0.42
- Malpractice RVU 0.05 changed to 0.07
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$67.29changed to$65.45
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 0.39 changed to 0.41
- Practice expense GPCI 0.908 changed to 0.896
- Malpractice GPCI 1.207 changed to 1.166
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
No ratechanged to$67.29
Held through RVU20B, RVU20C, RVU20D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1, RVU18B, RVU18C, RVU18D, RVU19A, RVU19B, RVU19C, RVU19D.

Rates in every CMS release
Effective from	Office	Facility	CMS release
2026-10-01	$72.39	$59.52	RVU26D
2026-07-01	$72.39	$59.52	RVU26C
2026-04-01	$72.39	$59.52	RVU26B
2026-01-01	$72.39	$59.52	RVU26A
2025-10-01	$66.75	$59.12	RVU25D
2025-07-01	$66.75	$59.12	RVU25C
2025-04-01	$66.75	$59.12	RVU25B
2025-01-01	$66.75	$59.12	RVU25A
2024-10-01	$65.76	$58.20	RVU24D
2024-07-01	$65.76	$58.20	RVU24C
2024-04-01	$65.76	$58.20	RVU24B
2024-03-09	$65.76	$58.20	RVU24AR
2024-01-01	$64.69	$57.25	RVU24A
2023-10-01	$63.86	$56.83	RVU23D
2023-07-01	$63.86	$56.83	RVU23C
2023-04-01	$63.86	$56.83	RVU23B
2023-01-01	$63.86	$56.83	RVU23A
2022-10-01	$66.03	$59.20	RVU22D
2022-07-01	$66.03	$59.20	RVU22C
2022-04-01	$66.03	$59.20	RVU22B
2022-01-01	$66.03	$59.20	RVU22A
2021-10-01	$65.45	$58.57	RVU21D
2021-07-01	$65.45	$58.57	RVU21C
2021-04-01	$65.45	$58.57	RVU21B
2021-01-01	$65.45	$58.57	RVU21A
2020-10-01	$67.29	$61.39	RVU20D
2020-07-01	$67.29	$61.39	RVU20C
2020-04-01	$67.29	$61.39	RVU20B
2020-01-01	$67.29	$61.39	RVU20A
2019-10-01	Not in this release	Not in this release	RVU19D
2019-07-01	Not in this release	Not in this release	RVU19C
2019-04-01	Not in this release	Not in this release	RVU19B
2019-01-01	Not in this release	Not in this release	RVU19A
2018-10-01	Not in this release	Not in this release	RVU18D
2018-07-01	Not in this release	Not in this release	RVU18C
2018-04-01	Not in this release	Not in this release	RVU18B
2018-01-01	Not in this release	Not in this release	RVU18AR1
2017-10-01	Not in this release	Not in this release	RVU17D
2017-07-01	Not in this release	Not in this release	RVU17C
2017-04-01	Not in this release	Not in this release	RVU17B
2017-01-01	Not in this release	Not in this release	RVU17A
2016-10-01	Not in this release	Not in this release	RVU16D
2016-07-01	Not in this release	Not in this release	RVU16C
2016-04-01	Not in this release	Not in this release	RVU16B
2016-01-01	Not in this release	Not in this release	RVU16A
2015-10-01	Not in this release	Not in this release	RVU15D
2015-07-01	Not in this release	Not in this release	RVU15C
2015-04-01	Not in this release	Not in this release	RVU15B
2015-01-01	Not in this release	Not in this release	RVU15A
2014-10-01	Not in this release	Not in this release	RVU14D
2014-07-01	Not in this release	Not in this release	RVU14C
2014-04-01	Not in this release	Not in this release	RVU14B
2014-01-01	Not in this release	Not in this release	RVU14A
2013-10-01	Not in this release	Not in this release	RVU13D
2013-07-01	Not in this release	Not in this release	RVU13C
2013-04-01	Not in this release	Not in this release	RVU13B
2013-01-01	Not in this release	Not in this release	RVU13AR

Price 96158 for an earlier date of service

Where the New Mexico rate applies

New Mexico is a Medicare payment area, not a city. Our Census mapping connects it to 528 cities and communities in New Mexico. Some span more than one payment area; confirm with the service ZIP.

Abeytas
Abiquiu
Acomita Lake
Adelino
Agua Fria
Alamillo
Alamo
Alamogordo

Browse all communities in New Mexico

96158 billing questions

How is 96158 different from 96156?

96156 describes a health behavior assessment or reassessment. Use 96158 when the service is an intervention intended to address behavioral or psychosocial factors affecting physical health or treatment.

When should 96159 be reported with 96158?

96158 represents the initial 30 minutes of individual intervention. Report 96159 for qualifying additional time, and document the time and intervention provided.

Can 96158 be used for a group session?

No. 96158 is for individual intervention with the patient. Group health behavior intervention is represented by 96164 for its initial time.

How does 96158 differ from psychotherapy?

96158 addresses behavioral or psychosocial factors that affect a physical health condition or its treatment. Psychotherapy codes describe treatment directed at a mental health condition.

What should the record support?

Document the physical health or treatment-related concern, the intervention and patient participation, and the time spent. The note should show that an individual face-to-face intervention was performed.

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

Show the CMS file lines behind this rate

RVUs for 96158PPRRVU2026_Oct_nonQPP.csv, line 12,765 (RVU26D)

12,76296139,,[CPT descriptor omitted],A,,0.00,1.06,,1.06,NA,0.00,1.06,1.06,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,04,0,99,0.00,0.00,0.00

12,76396146,,[CPT descriptor omitted],A,,0.00,0.06,,0.06,NA,0.01,0.07,0.07,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,04,0,99,0.00,0.00,0.00

12,76496156,,[CPT descriptor omitted],A,,2.40,0.80,,0.18,,0.02,3.22,2.60,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00

12,76596158,,[CPT descriptor omitted],A,,1.66,0.54,,0.12,,0.01,2.21,1.79,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00

12,76696159,,[CPT descriptor omitted],A,,0.57,0.19,,0.04,,0.00,0.76,0.61,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00

12,76796160,,[CPT descriptor omitted],A,,0.00,0.09,,0.09,NA,0.00,0.09,0.09,5,ZZZ,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00

12,76896161,,[CPT descriptor omitted],A,,0.00,0.10,,0.10,NA,0.00,0.10,0.10,5,ZZZ,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00

Geographic factors for New MexicoGPCI2026.csv, line 77 (RVU26D)

7414312,NH,40,NEW HAMPSHIRE,1.000,1.041,0.875

7512402,NJ,01,NORTHERN NJ,1.063,1.160,1.068

7612402,NJ,99,REST OF NEW JERSEY,1.040,1.092,1.097

7704212,NM,05,NEW MEXICO,1.000,0.917,1.201

7813202,NY,01,MANHATTAN,1.064,1.162,1.586

7913202,NY,02,NYC SUBURBS/LONG ISLAND,1.064,1.189,1.857

8013202,NY,03,POUGHKPSIE/N NYC SUBURBS,1.045,1.095,1.210

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What 96158 covers

How New Mexico compares for 96158

Every other payment area

96158 rates by state

How the 96158 rate is calculated

Payment rules and modifiers for 96158

Codes related to 96158

How 96158 has changed in New Mexico

Where the New Mexico rate applies

96158 billing questions

How is 96158 different from 96156?

When should 96159 be reported with 96158?

Can 96158 be used for a group session?

How does 96158 differ from psychotherapy?

What should the record support?

Where these rates come from

Did this answer your question about what 96158 pays in New Mexico?

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