CPT code 96158: Health behavior, individual, initial 30 minutes2026 Medicare rate & RVUs in Puerto Rico
Report 96158 for an individual face-to-face intervention addressing behavioral or psychosocial factors that affect a patient’s physical health or medical treatment.
In Puerto Rico, Medicare pays $74.01 for 96158 in the office and $59.83 when it’s performed in a hospital or facility.
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
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 Puerto Rico 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. Puerto Rico pays $74.01. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$74.01
- Los Angeles, CA · California$79.28+$5.27
- Washington, DC area · District of Columbia$80.06+$6.05
- Miami, FL · Florida$75.07+$1.06
- Chicago, IL · Illinois$74.73+$0.72
- Manhattan, NY · New York$80.48+$6.47
- Alaska · Alaska$102.56+$28.55
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| 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 |
| New MexicoNew Mexico | $72.39 | $59.52 |
| 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 |
| 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.
Explore a state
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
| 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 |
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
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 Puerto Rico 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
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.66 | × 1.000 | 1.6600 |
| Practice expense | 0.54 | × 1.011 | 0.5459 |
| Malpractice | 0.01 | × 0.985 | 0.0098 |
| Total RVUs | 2.2158 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Puerto Rico$74.01
Office: (1.66 × 1 + 0.54 × 1.011 + 0.01 × 0.985) × $33.4009 = $74.01
Facility: (1.66 × 1 + 0.12 × 1.011 + 0.01 × 0.985) × $33.4009 = $59.83
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?
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.
How 96158 has changed in Puerto Rico
96158 · Office / nonfacility
$74.01
Effective 2026-10-01
The base rate is $6.00 higher than on 2025-10-01, moving from $68.01 to $74.01 (8.8%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
$68.01changed to$74.01
- 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 1.007 changed to 1.011
- Malpractice GPCI 0.982 changed to 0.985
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$66.99changed to$68.01
- 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
$65.90changed to$66.99
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$65.16changed to$65.90
- 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 1.008 changed to 1.007
- Malpractice GPCI 0.984 changed to 0.982
October 1, 2023
RVU23D
$65.06changed to$65.16
- Practice expense GPCI 1.000 changed to 1.008
- Malpractice GPCI 1.000 changed to 0.984
January 1, 2023
RVU23A
$67.22changed to$65.06
- 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 1.008 changed to 1.000
- Malpractice GPCI 0.986 changed to 1.000
Held through RVU23B, RVU23C.
January 1, 2022
RVU22A
$66.74changed to$67.22
- 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
$68.30changed to$66.74
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 0.39 changed to 0.41
- Malpractice GPCI 0.988 changed to 0.986
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
No ratechanged to$68.30
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.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $74.01 | $59.83 | RVU26D |
| 2026-07-01 | $74.01 | $59.83 | RVU26C |
| 2026-04-01 | $74.01 | $59.83 | RVU26B |
| 2026-01-01 | $74.01 | $59.83 | RVU26A |
| 2025-10-01 | $68.01 | $59.54 | RVU25D |
| 2025-07-01 | $68.01 | $59.54 | RVU25C |
| 2025-04-01 | $68.01 | $59.54 | RVU25B |
| 2025-01-01 | $68.01 | $59.54 | RVU25A |
| 2024-10-01 | $66.99 | $58.61 | RVU24D |
| 2024-07-01 | $66.99 | $58.61 | RVU24C |
| 2024-04-01 | $66.99 | $58.61 | RVU24B |
| 2024-03-09 | $66.99 | $58.61 | RVU24AR |
| 2024-01-01 | $65.90 | $57.65 | RVU24A |
| 2023-10-01 | $65.16 | $57.30 | RVU23D |
| 2023-07-01 | $65.06 | $57.27 | RVU23C |
| 2023-04-01 | $65.06 | $57.27 | RVU23B |
| 2023-01-01 | $65.06 | $57.27 | RVU23A |
| 2022-10-01 | $67.22 | $59.54 | RVU22D |
| 2022-07-01 | $67.22 | $59.54 | RVU22C |
| 2022-04-01 | $67.22 | $59.54 | RVU22B |
| 2022-01-01 | $67.22 | $59.54 | RVU22A |
| 2021-10-01 | $66.74 | $59.00 | RVU21D |
| 2021-07-01 | $66.74 | $59.00 | RVU21C |
| 2021-04-01 | $66.74 | $59.00 | RVU21B |
| 2021-01-01 | $66.74 | $59.00 | RVU21A |
| 2020-10-01 | $68.30 | $61.75 | RVU20D |
| 2020-07-01 | $68.30 | $61.75 | RVU20C |
| 2020-04-01 | $68.30 | $61.75 | RVU20B |
| 2020-01-01 | $68.30 | $61.75 | 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 |
Where the Puerto Rico rate applies
Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.
- Aceitunas
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aguas Claras
- Aguilita
- Aibonito
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
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