CPT code 96159: Health behavior intervention, individual, additional time2026 Medicare rate & RVUs in New Mexico
Report 96159 for additional time spent in an individual health behavior intervention addressing behavioral factors that affect a patient’s physical health.
In New Mexico, Medicare pays $24.86 for 96159 in the office and $20.26 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 96159 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 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.
How New Mexico compares for 96159
Across 109 of 109 payment localities, the office rate for 96159 runs from $24.49 in Arkansas to $35.32 in Alaska. New Mexico pays $24.86. The RVUs are the same everywhere; the geographic indexes change the dollars.
- New Mexico · this page$24.86
- Los Angeles, CA · California$27.33+$2.47
- Washington, DC area · District of Columbia$27.54+$2.68
- Miami, FL · Florida$25.64+$0.78
- Chicago, IL · Illinois$25.55+$0.69
- Manhattan, NY · New York$27.63+$2.77
- Alaska · Alaska$35.32+$10.46
Other areas in New Mexico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $24.59 | $20.21 |
| ArkansasArkansas | $24.49 | $20.19 |
| ArizonaArizona | $25.19 | $20.33 |
| Bakersfield, CACalifornia | $26.36 | $20.86 |
| Chico, CACalifornia | $26.32 | $20.83 |
| El Centro, CACalifornia | $26.32 | $20.83 |
| Fresno, CACalifornia | $26.32 | $20.83 |
| Hanford, CACalifornia | $26.32 | $20.83 |
| Madera, CACalifornia | $26.32 | $20.83 |
| Merced, CACalifornia | $26.32 | $20.83 |
| Modesto, CACalifornia | $26.32 | $20.83 |
| Napa, CACalifornia | $28.60 | $22.00 |
| Oxnard, CACalifornia | $27.07 | $21.15 |
| Redding, CACalifornia | $26.32 | $20.83 |
| Rest of CaliforniaCalifornia | $26.32 | $20.83 |
| Riverside, CACalifornia | $26.34 | $20.85 |
| Sacramento, CACalifornia | $27.10 | $21.28 |
| Salinas, CACalifornia | $26.98 | $21.18 |
| San Diego, CACalifornia | $27.20 | $21.21 |
| Marin County, CACalifornia | $29.80 | $22.73 |
| San Francisco, CACalifornia | $29.80 | $22.73 |
| San Benito County, CACalifornia | $30.28 | $23.06 |
| Santa Clara County, CACalifornia | $30.28 | $23.06 |
| San Luis Obispo, CACalifornia | $26.59 | $20.88 |
| Santa Cruz, CACalifornia | $27.15 | $21.06 |
| Santa Maria, CACalifornia | $26.97 | $21.13 |
| Santa Rosa, CACalifornia | $27.40 | $21.25 |
| Stockton, CACalifornia | $26.32 | $20.83 |
| Vallejo, CACalifornia | $28.60 | $22.00 |
| Visalia, CACalifornia | $26.32 | $20.83 |
| Yuba City, CACalifornia | $26.32 | $20.83 |
| ColoradoColorado | $26.02 | $20.69 |
| ConnecticutConnecticut | $26.25 | $20.86 |
| DelawareDelaware | $25.40 | $20.45 |
| Fort Lauderdale, FLFlorida | $25.47 | $20.39 |
| Rest of FloridaFlorida | $25.11 | $20.32 |
| Atlanta, GAGeorgia | $25.54 | $20.45 |
| Rest of GeorgiaGeorgia | $24.70 | $20.23 |
| Hawaii, Guam, HIHawaii | $26.25 | $20.56 |
| IowaIowa | $24.85 | $20.26 |
| IdahoIdaho | $24.88 | $20.27 |
| East St. Louis, ILIllinois | $24.88 | $20.27 |
| Rest of IllinoisIllinois | $24.83 | $20.26 |
| Suburban Chicago, ILIllinois | $25.69 | $20.54 |
| IndianaIndiana | $24.92 | $20.28 |
| KansasKansas | $24.78 | $20.25 |
| KentuckyKentucky | $24.68 | $20.23 |
| New Orleans, LALouisiana | $25.01 | $20.30 |
| Rest of LouisianaLouisiana | $24.65 | $20.22 |
| Metropolitan Boston, MAMassachusetts | $27.40 | $21.41 |
| Rest of MassachusettsMassachusetts | $26.03 | $20.75 |
| Baltimore area, MDMaryland | $26.15 | $20.78 |
| Rest of MarylandMaryland | $25.65 | $20.58 |
| Rest of MaineMaine | $24.88 | $20.27 |
| Southern Maine, MEMaine | $25.33 | $20.36 |
| Detroit, MIMichigan | $25.16 | $20.33 |
| Rest of MichiganMichigan | $24.83 | $20.26 |
| MinnesotaMinnesota | $25.57 | $20.41 |
| Metropolitan Kansas City, MOMissouri | $25.00 | $20.29 |
| Metropolitan St. Louis, MOMissouri | $25.08 | $20.31 |
| Rest of MissouriMissouri | $24.51 | $20.19 |
| MississippiMississippi | $24.50 | $20.19 |
| MontanaMontana | $25.38 | $20.37 |
| North CarolinaNorth Carolina | $24.96 | $20.29 |
| North DakotaNorth Dakota | $25.38 | $20.37 |
| NebraskaNebraska | $24.90 | $20.27 |
| New HampshireNew Hampshire | $25.64 | $20.43 |
| Northern New JerseyNew Jersey | $27.60 | $21.79 |
| Rest of New JerseyNew Jersey | $26.73 | $21.26 |
| NevadaNevada | $25.39 | $20.38 |
| NYC suburbs and Long Island, NYNew York | $27.80 | $21.85 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $26.84 | $21.36 |
| Queens, NYNew York | $27.76 | $21.84 |
| Rest of New YorkNew York | $25.07 | $20.31 |
| OhioOhio | $24.83 | $20.26 |
| OklahomaOklahoma | $24.71 | $20.23 |
| Portland, OROregon | $26.39 | $20.83 |
| Rest of OregonOregon | $25.36 | $20.37 |
| Metropolitan Philadelphia, PAPennsylvania | $25.99 | $20.77 |
| Rest of PennsylvaniaPennsylvania | $24.86 | $20.26 |
| Puerto RicoPuerto Rico | $25.45 | $20.39 |
| Rhode IslandRhode Island | $25.96 | $20.78 |
| South CarolinaSouth Carolina | $24.90 | $20.27 |
| South DakotaSouth Dakota | $25.38 | $20.37 |
| TennesseeTennessee | $24.81 | $20.25 |
| Austin, TXTexas | $25.79 | $20.49 |
| Beaumont, TXTexas | $24.81 | $20.25 |
| Brazoria, TXTexas | $25.48 | $20.51 |
| Dallas, TXTexas | $25.53 | $20.54 |
| Fort Worth, TXTexas | $25.47 | $20.53 |
| Galveston, TXTexas | $25.49 | $20.52 |
| Houston, TXTexas | $25.49 | $20.52 |
| Rest of TexasTexas | $25.06 | $20.31 |
| UtahUtah | $25.00 | $20.29 |
| VirginiaVirginia | $25.28 | $20.35 |
| Virgin Islands, VIUnited States Virgin Islands | $25.45 | $20.39 |
| VermontVermont | $25.32 | $20.36 |
| Rest of WashingtonWashington | $25.97 | $20.69 |
| King County, WAWashington | $27.78 | $21.63 |
| WisconsinWisconsin | $25.12 | $20.32 |
| West VirginiaWest Virginia | $24.55 | $20.20 |
| WyomingWyoming | $25.38 | $20.37 |
96159 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.
$24.49
$35.32
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 | $35.32 | 1 |
| AL | $24.59 | 1 |
| AR | $24.49 | 1 |
| AZ | $25.19 | 1 |
| CA | $26.32–$30.28 | 29 |
| CO | $26.02 | 1 |
| CT | $26.25 | 1 |
| DC | $27.54 | 1 |
| DE | $25.40 | 1 |
| FL | $25.11–$25.64 | 3 |
| GA | $24.70–$25.54 | 2 |
| GU | $26.25 | 1 |
| HI | $26.25 | 1 |
| IA | $24.85 | 1 |
| ID | $24.88 | 1 |
| IL | $24.83–$25.69 | 4 |
| IN | $24.92 | 1 |
| KS | $24.78 | 1 |
| KY | $24.68 | 1 |
| LA | $24.65–$25.01 | 2 |
| MA | $26.03–$27.40 | 2 |
| MD | $25.65–$27.54 | 3 |
| ME | $24.88–$25.33 | 2 |
| MI | $24.83–$25.16 | 2 |
| MN | $25.57 | 1 |
| MO | $24.51–$25.08 | 3 |
| MS | $24.50 | 1 |
| MT | $25.38 | 1 |
| NC | $24.96 | 1 |
| ND | $25.38 | 1 |
| NE | $24.90 | 1 |
| NH | $25.64 | 1 |
| NJ | $26.73–$27.60 | 2 |
| NM | $24.86 | 1 |
| NV | $25.39 | 1 |
| NY | $25.07–$27.80 | 5 |
| OH | $24.83 | 1 |
| OK | $24.71 | 1 |
| OR | $25.36–$26.39 | 2 |
| PA | $24.86–$25.99 | 2 |
| PR | $25.45 | 1 |
| RI | $25.96 | 1 |
| SC | $24.90 | 1 |
| SD | $25.38 | 1 |
| TN | $24.81 | 1 |
| TX | $24.81–$25.79 | 8 |
| UT | $25.00 | 1 |
| VA | $25.28–$27.54 | 2 |
| VI | $25.45 | 1 |
| VT | $25.32 | 1 |
| WA | $25.97–$27.78 | 2 |
| WI | $25.12 | 1 |
| WV | $24.55 | 1 |
| WY | $25.38 | 1 |
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.
The exact New Mexico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
12,766
- Code
- 96159
- Physician work
- 0.57
- Practice expense
- 0.19
- Malpractice
- 0.00
GPCI2026.csv
77
- Locality
- New Mexico
- Physician work
- 1.000
- Practice expense
- 0.917
- Malpractice
- 1.201
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.57 | × 1.000 | 0.5700 |
| Practice expense | 0.19 | × 0.917 | 0.1742 |
| Malpractice | 0.00 | × 1.201 | 0.0000 |
| Total RVUs | 0.7442 | ||
| Conversion factor | × 33.4009 | ||
Office rate, New Mexico$24.86
Office: (0.57 × 1 + 0.19 × 0.917 + 0 × 1.201) × $33.4009 = $24.86
Facility: (0.57 × 1 + 0.04 × 0.917 + 0 × 1.201) × $33.4009 = $20.26
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. |
How 96159 has changed in New Mexico
96159 · Office / nonfacility
$24.86
Effective 2026-10-01
The base rate is $1.99 higher than on 2025-10-01, moving from $22.87 to $24.86 (8.7%).
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
$22.87changed to$24.86
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.55 changed to 0.57
- Practice expense RVU 0.16 changed to 0.19
- Malpractice RVU 0.01 changed to 0.00
- 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
$22.23changed to$22.87
- Conversion factor 33.2875 changed to 32.3465
- Work RVU 0.52 changed to 0.55
- Practice expense RVU 0.15 changed to 0.16
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$21.87changed to$22.23
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$21.92changed to$21.87
- Conversion factor 33.8872 changed to 32.7442
- Work RVU 0.50 changed to 0.52
- Practice expense GPCI 0.902 changed to 0.908
- Malpractice GPCI 1.169 changed to 1.172
January 1, 2023
RVU23A
$22.45changed to$21.92
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 0.14 changed to 0.15
- Malpractice RVU 0.02 changed to 0.01
- 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
$22.64changed to$22.45
- Conversion factor 34.8931 changed to 34.6062
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$23.50changed to$22.64
- Conversion factor 36.0896 changed to 34.8931
- 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$23.50
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 | $24.86 | $20.26 | RVU26D |
| 2026-07-01 | $24.86 | $20.26 | RVU26C |
| 2026-04-01 | $24.86 | $20.26 | RVU26B |
| 2026-01-01 | $24.86 | $20.26 | RVU26A |
| 2025-10-01 | $22.87 | $20.23 | RVU25D |
| 2025-07-01 | $22.87 | $20.23 | RVU25C |
| 2025-04-01 | $22.87 | $20.23 | RVU25B |
| 2025-01-01 | $22.87 | $20.23 | RVU25A |
| 2024-10-01 | $22.23 | $19.51 | RVU24D |
| 2024-07-01 | $22.23 | $19.51 | RVU24C |
| 2024-04-01 | $22.23 | $19.51 | RVU24B |
| 2024-03-09 | $22.23 | $19.51 | RVU24AR |
| 2024-01-01 | $21.87 | $19.19 | RVU24A |
| 2023-10-01 | $21.92 | $19.48 | RVU23D |
| 2023-07-01 | $21.92 | $19.48 | RVU23C |
| 2023-04-01 | $21.92 | $19.48 | RVU23B |
| 2023-01-01 | $21.92 | $19.48 | RVU23A |
| 2022-10-01 | $22.45 | $19.97 | RVU22D |
| 2022-07-01 | $22.45 | $19.97 | RVU22C |
| 2022-04-01 | $22.45 | $19.97 | RVU22B |
| 2022-01-01 | $22.45 | $19.97 | RVU22A |
| 2021-10-01 | $22.64 | $20.45 | RVU21D |
| 2021-07-01 | $22.64 | $20.45 | RVU21C |
| 2021-04-01 | $22.64 | $20.45 | RVU21B |
| 2021-01-01 | $22.64 | $20.45 | RVU21A |
| 2020-10-01 | $23.50 | $21.21 | RVU20D |
| 2020-07-01 | $23.50 | $21.21 | RVU20C |
| 2020-04-01 | $23.50 | $21.21 | RVU20B |
| 2020-01-01 | $23.50 | $21.21 | 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 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
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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