CPT code 96160: Health risk assessment, patient-focused instrument2026 Medicare rate & RVUs in Missouri
Report this service for administering and documenting a standardized instrument that assesses a patient’s health risks, alongside a qualifying primary procedure.
Medicare pays $2.59–$2.86 for 96160 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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On this page 9 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.
Where 96160 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
$2.59 to $2.86
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $2.82 | Unavailable |
| Metropolitan St. Louis, MO | $2.86 | Unavailable |
| Rest of Missouri | $2.59 | Unavailable |
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.
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. |
96160 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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