CPT code 96159: Health behavior intervention, individual, additional time2026 Medicare rate & RVUs in Missouri
Report 96159 for additional time spent in an individual health behavior intervention addressing behavioral factors that affect a patient’s physical health.
Medicare pays $24.51–$25.08 for 96159 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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What 96159 covers
This add-on represents additional face-to-face time in an individual intervention focused on behavior affecting physical health. A physician or other qualified health care professional may use the service to help a patient address challenges such as following a chronic disease treatment plan, improving self-management, or coping with pain. The work is directed toward changing health-related behavior, rather than administering or interpreting psychological tests.
Report 96159 with the primary individual intervention code, 96158, when the documented service extends beyond its initial time. The record should identify the health-related behavioral target, intervention provided, patient participation, and time supporting the additional units. It is not a stand-alone service. CMS classifies 96159 as an add-on and pays it within the primary procedure’s global period.
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 96159 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
$24.51 to $25.08
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $25.00 | $20.29 |
| Metropolitan St. Louis, MO | $25.08 | $20.31 |
| Rest of Missouri | $24.51 | $20.19 |
How the 96159 rate is calculated
Each of 96159’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 · 96159
RVUs × geographic indexes × conversion factor
Work0.57
0.57 RVUs× 1.000 GPCI
Practice expense0.19
0.19 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
0.7600
Conversion factor
$33.4009
Medicare rate
$25.38
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 96159
The CMS indicators that decide how 96159 is paid alongside other services.
CMS payment indicators · 96159
Health behavior intervention, individual, additional time
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
96159 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 96158Health behaviorIndividual, initial 30 minutes
- 96158 covers the initial individual intervention time; 96159 is the add-on for additional time and is reported with 96158.
- 96156Health behavior assessmentAssessment or reassessment
- 96156 describes health behavior assessment or reassessment. Choose 96159 only for additional time spent delivering an individual intervention.
- 96164Group interventionFirst 30 minutes
- 96164 is for an initial group intervention. 96159 is for additional time in an individual intervention, not group work.
- 96167Family interventionPatient present, initial 30 minutes
- 96167 is the initial family intervention code for a session with the patient present; 96159 is additional individual intervention time.
96159 billing questions
When should 96159 be reported instead of 96158?
96158 represents the initial individual intervention time. Report 96159 for additional intervention time after that initial service, with 96158 as the primary code.
Can 96159 be billed by itself?
No. It is an add-on code and must be reported with its primary individual intervention code, 96158.
What should the note support?
Document the health-related behavior addressed, the intervention performed, patient participation, and the additional time. The note should distinguish intervention from assessment or testing.
Is this code for group counseling or family intervention?
No. 96159 is for additional time in an individual intervention. Group and family formats have separate health behavior intervention codes.
How does 96159 differ from 96156?
96156 represents a health behavior assessment or reassessment. 96159 represents additional time providing an individual intervention, paired with 96158.
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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