CPT code 96160: Health risk assessment, patient-focused instrument2026 Medicare rate & RVUs

Medicare pays $3.01 for 96160 nationally in the office. Local office rates run $2.58–$4.33.

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

What 96160 covers

This service covers a standardized instrument focused on the patient’s health risks, such as a health hazard appraisal, including the instrument’s scoring and documentation. The patient may complete the questions during a physician-office encounter, with practice staff administering or scoring the instrument under physician supervision when the service is billed incident-to.

Select this code when the documented service is a patient-focused risk instrument, rather than a clinician’s broader health behavior assessment or a brief emotional or behavioral screen. Keep the instrument, score, and resulting documentation in the record. CMS treats the code as an add-on: report it only with a primary procedure, and payment falls within that procedure’s global period. CMS assigns zero work and malpractice RVUs, with practice-expense RVUs in both 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 96160 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

96160 rates by state

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

How the 96160 rate is calculated

Each of 96160’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.

Payment rules and modifiers for 96160

The CMS indicators that decide how 96160 is paid alongside other services.

96160 compared with similar codes

How to choose

96161Health risk assessmentCaregiver-focused instrument

Choose 96160 when the instrument assesses the patient’s health risks; choose 96161 when it assesses the caregiver’s health risks.

96127Behavioral screening toolPer scored standardized instrument

96127 is for a brief emotional or behavioral assessment. 96160 addresses patient-focused health risks using a standardized instrument.

96156Health behavior assessmentAssessment or reassessment

96156 describes a health behavior assessment or reassessment; 96160 covers administration, scoring, and documentation of a patient-focused risk instrument.

Codes related to 96160

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

Open CMS sourceHow we calculate rates