CPT code 96160: Health risk assessment, patient-focused instrument2026 Medicare rate & RVUs in Washington, DC area
Report this service for administering and documenting a standardized instrument that assesses a patient’s health risks, alongside a qualifying primary procedure.
In Washington, DC area, Medicare pays $3.54 for 96160 in the office.
Check a contract rate as a % of Medicare · 96160 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 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.
How Washington, DC area compares for 96160
Across 109 of 109 payment localities, the office rate for 96160 runs from $2.58 in Arkansas to $4.33 in Santa Clara County, CA. Washington, DC area pays $3.54. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Washington, DC area · this page$3.54
- Los Angeles, CA · California$3.56+$0.02
- Miami, FL · Florida$3.13−$0.41
- Chicago, IL · Illinois$3.02−$0.52
- Manhattan, NY · New York$3.49−$0.05
- Alaska · Alaska$3.20−$0.34
- Alabama · Alabama$2.63−$0.91
Other areas in District of Columbia first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| ArkansasArkansas | $2.58 | — |
| ArizonaArizona | $2.91 | — |
| Bakersfield, CACalifornia | $3.29 | — |
| Chico, CACalifornia | $3.29 | — |
| El Centro, CACalifornia | $3.29 | — |
| Fresno, CACalifornia | $3.29 | — |
| Hanford, CACalifornia | $3.29 | — |
| Madera, CACalifornia | $3.29 | — |
| Merced, CACalifornia | $3.29 | — |
| Modesto, CACalifornia | $3.29 | — |
| Napa, CACalifornia | $3.96 | — |
| Oxnard, CACalifornia | $3.55 | — |
| Redding, CACalifornia | $3.29 | — |
| Rest of CaliforniaCalifornia | $3.29 | — |
| Riverside, CACalifornia | $3.29 | — |
| Sacramento, CACalifornia | $3.50 | — |
| Salinas, CACalifornia | $3.48 | — |
| San Diego, CACalifornia | $3.60 | — |
| Marin County, CACalifornia | $4.24 | — |
| San Francisco, CACalifornia | $4.24 | — |
| San Benito County, CACalifornia | $4.33 | — |
| Santa Clara County, CACalifornia | $4.33 | — |
| San Luis Obispo, CACalifornia | $3.42 | — |
| Santa Cruz, CACalifornia | $3.65 | — |
| Santa Maria, CACalifornia | $3.51 | — |
| Santa Rosa, CACalifornia | $3.69 | — |
| Stockton, CACalifornia | $3.29 | — |
| Vallejo, CACalifornia | $3.96 | — |
| Visalia, CACalifornia | $3.29 | — |
| Yuba City, CACalifornia | $3.29 | — |
| ColoradoColorado | $3.20 | — |
| ConnecticutConnecticut | $3.24 | — |
| DelawareDelaware | $2.97 | — |
| Fort Lauderdale, FLFlorida | $3.05 | — |
| Rest of FloridaFlorida | $2.87 | — |
| Atlanta, GAGeorgia | $3.05 | — |
| Rest of GeorgiaGeorgia | $2.68 | — |
| Hawaii, Guam, HIHawaii | $3.42 | — |
| IowaIowa | $2.75 | — |
| IdahoIdaho | $2.77 | — |
| East St. Louis, ILIllinois | $2.77 | — |
| Rest of IllinoisIllinois | $2.74 | — |
| Suburban Chicago, ILIllinois | $3.09 | — |
| IndianaIndiana | $2.79 | — |
| KansasKansas | $2.72 | — |
| KentuckyKentucky | $2.67 | — |
| New Orleans, LALouisiana | $2.83 | — |
| Rest of LouisianaLouisiana | $2.66 | — |
| Metropolitan Boston, MAMassachusetts | $3.59 | — |
| Rest of MassachusettsMassachusetts | $3.17 | — |
| Baltimore area, MDMaryland | $3.23 | — |
| Rest of MarylandMaryland | $3.04 | — |
| Rest of MaineMaine | $2.77 | — |
| Southern Maine, MEMaine | $2.98 | — |
| Detroit, MIMichigan | $2.90 | — |
| Rest of MichiganMichigan | $2.74 | — |
| MinnesotaMinnesota | $3.09 | — |
| Metropolitan Kansas City, MOMissouri | $2.82 | — |
| Metropolitan St. Louis, MOMissouri | $2.86 | — |
| Rest of MissouriMissouri | $2.59 | — |
| MississippiMississippi | $2.59 | — |
| MontanaMontana | $3.01 | — |
| North CarolinaNorth Carolina | $2.80 | — |
| North DakotaNorth Dakota | $3.01 | — |
| NebraskaNebraska | $2.77 | — |
| New HampshireNew Hampshire | $3.13 | — |
| Northern New JerseyNew Jersey | $3.49 | — |
| Rest of New JerseyNew Jersey | $3.28 | — |
| New MexicoNew Mexico | $2.76 | — |
| NevadaNevada | $3.01 | — |
| NYC suburbs and Long Island, NYNew York | $3.57 | — |
| Poughkeepsie and northern NYC suburbs, NYNew York | $3.29 | — |
| Queens, NYNew York | $3.55 | — |
| Rest of New YorkNew York | $2.86 | — |
| OhioOhio | $2.74 | — |
| OklahomaOklahoma | $2.68 | — |
| Portland, OROregon | $3.34 | — |
| Rest of OregonOregon | $2.99 | — |
| Metropolitan Philadelphia, PAPennsylvania | $3.13 | — |
| Rest of PennsylvaniaPennsylvania | $2.76 | — |
| Puerto RicoPuerto Rico | $3.04 | — |
| Rhode IslandRhode Island | $3.11 | — |
| South CarolinaSouth Carolina | $2.78 | — |
| South DakotaSouth Dakota | $3.01 | — |
| TennesseeTennessee | $2.73 | — |
| Austin, TXTexas | $3.18 | — |
| Beaumont, TXTexas | $2.74 | — |
| Brazoria, TXTexas | $2.98 | — |
| Dallas, TXTexas | $2.99 | — |
| Fort Worth, TXTexas | $2.96 | — |
| Galveston, TXTexas | $2.99 | — |
| Houston, TXTexas | $2.99 | — |
| Rest of TexasTexas | $2.85 | — |
| UtahUtah | $2.83 | — |
| VirginiaVirginia | $2.95 | — |
| Virgin Islands, VIUnited States Virgin Islands | $3.04 | — |
| VermontVermont | $2.98 | — |
| Rest of WashingtonWashington | $3.17 | — |
| King County, WAWashington | $3.69 | — |
| WisconsinWisconsin | $2.88 | — |
| West VirginiaWest Virginia | $2.61 | — |
| WyomingWyoming | $3.01 | — |
96160 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.
$2.58
$3.81
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 | $3.20 | 1 |
| AL | $2.63 | 1 |
| AR | $2.58 | 1 |
| AZ | $2.91 | 1 |
| CA | $3.29–$4.33 | 29 |
| CO | $3.20 | 1 |
| CT | $3.24 | 1 |
| DC | $3.54 | 1 |
| DE | $2.97 | 1 |
| FL | $2.87–$3.13 | 3 |
| GA | $2.68–$3.05 | 2 |
| GU | $3.42 | 1 |
| HI | $3.42 | 1 |
| IA | $2.75 | 1 |
| ID | $2.77 | 1 |
| IL | $2.74–$3.09 | 4 |
| IN | $2.79 | 1 |
| KS | $2.72 | 1 |
| KY | $2.67 | 1 |
| LA | $2.66–$2.83 | 2 |
| MA | $3.17–$3.59 | 2 |
| MD | $3.04–$3.54 | 3 |
| ME | $2.77–$2.98 | 2 |
| MI | $2.74–$2.90 | 2 |
| MN | $3.09 | 1 |
| MO | $2.59–$2.86 | 3 |
| MS | $2.59 | 1 |
| MT | $3.01 | 1 |
| NC | $2.80 | 1 |
| ND | $3.01 | 1 |
| NE | $2.77 | 1 |
| NH | $3.13 | 1 |
| NJ | $3.28–$3.49 | 2 |
| NM | $2.76 | 1 |
| NV | $3.01 | 1 |
| NY | $2.86–$3.57 | 5 |
| OH | $2.74 | 1 |
| OK | $2.68 | 1 |
| OR | $2.99–$3.34 | 2 |
| PA | $2.76–$3.13 | 2 |
| PR | $3.04 | 1 |
| RI | $3.11 | 1 |
| SC | $2.78 | 1 |
| SD | $3.01 | 1 |
| TN | $2.73 | 1 |
| TX | $2.74–$3.18 | 8 |
| UT | $2.83 | 1 |
| VA | $2.95–$3.54 | 2 |
| VI | $3.04 | 1 |
| VT | $2.98 | 1 |
| WA | $3.17–$3.69 | 2 |
| WI | $2.88 | 1 |
| WV | $2.61 | 1 |
| WY | $3.01 | 1 |
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.
How the rate is built · 96160
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.09
0.09 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
0.0900
Conversion factor
$33.4009
Medicare rate
$3.01
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Washington, DC area inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
12,767
- Code
- 96160
- Physician work
- 0.00
- Practice expense
- 0.09
- Malpractice
- 0.00
GPCI2026.csv
39
- Locality
- Washington, DC area
- Physician work
- 1.054
- Practice expense
- 1.178
- Malpractice
- 1.113
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.00 | × 1.054 | 0.0000 |
| Practice expense | 0.09 | × 1.178 | 0.1060 |
| Malpractice | 0.00 | × 1.113 | 0.0000 |
| Total RVUs | 0.1060 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Washington, DC area$3.54
Office: (0 × 1.054 + 0.09 × 1.178 + 0 × 1.113) × $33.4009 = $3.54
Payment rules and modifiers for 96160
The CMS indicators that decide how 96160 is paid alongside other services.
CMS payment indicators · 96160
Health risk assessment, patient-focused instrument
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 9 | The concept doesn’t apply. |
| Bilateral (modifier 50) | 9 | The concept doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 9 | The concept doesn’t apply. |
| Co-surgeons (62) | 9 | The concept doesn’t apply. |
| Team surgery (66) | 9 | The concept doesn’t apply. |
| Professional/technical | 5 | Incident-to service. |
How 96160 has changed in Washington, DC area
96160 · Office / nonfacility
$3.54
Effective 2026-10-01
The base rate is $0.07 higher than on 2025-10-01, moving from $3.47 to $3.54 (2.0%).
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
$3.47changed to$3.54
- Conversion factor 32.3465 changed to 33.4009
- Work GPCI 1.057 changed to 1.054
- Practice expense GPCI 1.192 changed to 1.178
- Malpractice GPCI 1.168 changed to 1.113
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$3.57changed to$3.47
- Conversion factor 33.2875 changed to 32.3465
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$3.51changed to$3.57
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$3.29changed to$3.51
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 0.08 changed to 0.09
- Work GPCI 1.056 changed to 1.057
- Practice expense GPCI 1.214 changed to 1.192
- Malpractice GPCI 1.231 changed to 1.168
January 1, 2023
RVU23A
$3.42changed to$3.29
- Conversion factor 34.6062 changed to 33.8872
- Work GPCI 1.054 changed to 1.056
- Practice expense GPCI 1.236 changed to 1.214
- Malpractice GPCI 1.294 changed to 1.231
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$3.45changed to$3.42
- Conversion factor 34.8931 changed to 34.6062
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$3.08changed to$3.45
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 0.07 changed to 0.08
- Work GPCI 1.049 changed to 1.054
- Practice expense GPCI 1.221 changed to 1.236
- Malpractice GPCI 1.277 changed to 1.294
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$3.91changed to$3.08
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 0.09 changed to 0.07
- Work GPCI 1.045 changed to 1.049
- Practice expense GPCI 1.205 changed to 1.221
- Malpractice GPCI 1.261 changed to 1.277
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$4.77changed to$3.91
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 0.11 changed to 0.09
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$5.62changed to$4.77
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 0.13 changed to 0.11
- Work GPCI 1.048 changed to 1.045
- Malpractice GPCI 1.271 changed to 1.261
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
No ratechanged to$5.62
Held through RVU17B, RVU17C, RVU17D.
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.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $3.54 | Not available in this setting | RVU26D |
| 2026-07-01 | $3.54 | Not available in this setting | RVU26C |
| 2026-04-01 | $3.54 | Not available in this setting | RVU26B |
| 2026-01-01 | $3.54 | Not available in this setting | RVU26A |
| 2025-10-01 | $3.47 | Not available in this setting | RVU25D |
| 2025-07-01 | $3.47 | Not available in this setting | RVU25C |
| 2025-04-01 | $3.47 | Not available in this setting | RVU25B |
| 2025-01-01 | $3.47 | Not available in this setting | RVU25A |
| 2024-10-01 | $3.57 | Not available in this setting | RVU24D |
| 2024-07-01 | $3.57 | Not available in this setting | RVU24C |
| 2024-04-01 | $3.57 | Not available in this setting | RVU24B |
| 2024-03-09 | $3.57 | Not available in this setting | RVU24AR |
| 2024-01-01 | $3.51 | Not available in this setting | RVU24A |
| 2023-10-01 | $3.29 | Not available in this setting | RVU23D |
| 2023-07-01 | $3.29 | Not available in this setting | RVU23C |
| 2023-04-01 | $3.29 | Not available in this setting | RVU23B |
| 2023-01-01 | $3.29 | Not available in this setting | RVU23A |
| 2022-10-01 | $3.42 | Not available in this setting | RVU22D |
| 2022-07-01 | $3.42 | Not available in this setting | RVU22C |
| 2022-04-01 | $3.42 | Not available in this setting | RVU22B |
| 2022-01-01 | $3.42 | Not available in this setting | RVU22A |
| 2021-10-01 | $3.45 | Not available in this setting | RVU21D |
| 2021-07-01 | $3.45 | Not available in this setting | RVU21C |
| 2021-04-01 | $3.45 | Not available in this setting | RVU21B |
| 2021-01-01 | $3.45 | Not available in this setting | RVU21A |
| 2020-10-01 | $3.08 | Not available in this setting | RVU20D |
| 2020-07-01 | $3.08 | Not available in this setting | RVU20C |
| 2020-04-01 | $3.08 | Not available in this setting | RVU20B |
| 2020-01-01 | $3.08 | Not available in this setting | RVU20A |
| 2019-10-01 | $3.91 | Not available in this setting | RVU19D |
| 2019-07-01 | $3.91 | Not available in this setting | RVU19C |
| 2019-04-01 | $3.91 | Not available in this setting | RVU19B |
| 2019-01-01 | $3.91 | Not available in this setting | RVU19A |
| 2018-10-01 | $4.77 | Not available in this setting | RVU18D |
| 2018-07-01 | $4.77 | Not available in this setting | RVU18C |
| 2018-04-01 | $4.77 | Not available in this setting | RVU18B |
| 2018-01-01 | $4.77 | Not available in this setting | RVU18AR1 |
| 2017-10-01 | $5.62 | Not available in this setting | RVU17D |
| 2017-07-01 | $5.62 | Not available in this setting | RVU17C |
| 2017-04-01 | $5.62 | Not available in this setting | RVU17B |
| 2017-01-01 | $5.62 | Not available in this setting | 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 Washington, DC area rate applies
Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.
- Washington
96160 billing questions
Can 96160 be billed by itself?
No. CMS identifies it as an add-on code, so the claim must include a primary procedure; payment falls within that procedure’s global period.
What documentation supports 96160?
Document the standardized patient-focused risk instrument, its administration, the score, and the resulting assessment information.
Can practice staff administer or score the instrument?
The service may be billed incident-to only when performed under physician supervision.
How is 96160 different from 96127?
96160 concerns a patient-focused health risk instrument. 96127 is for a brief emotional or behavioral assessment.
Is 96160 interchangeable with a caregiver risk assessment?
No. 96160 is focused on the patient; 96161 is the related code for a caregiver-focused health risk assessment.
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
Fee sheets · Coming soon
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