CPT code 96161: Health risk assessment, caregiver-focused instrument2026 Medicare rate & RVUs

Medicare pays $3.34 for 96161 nationally in the office. Local office rates run $2.87–$4.82.

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

What 96161 covers

This service covers a standardized health risk instrument completed by a patient’s caregiver for the patient’s benefit, followed by scoring and documentation. A typical example is a caregiver completing a depression or stress screening during a child’s visit. The instrument concerns the caregiver’s health risks as they relate to the patient’s care; it is not a general clinical evaluation of the caregiver for the caregiver’s own treatment. The service may be provided in an office or another setting where the patient is receiving care.

Choose this code when the caregiver-focused instrument is administered, scored, and documented, rather than when the patient completes the instrument. Record the instrument used, who completed it, the score or result, and its relevance to the patient’s care. CMS treats this as an add-on code: report it only with a primary procedure, and payment falls within that procedure’s global period. It is an incident-to service and may be billed only when performed under physician supervision.

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 96161 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

96161 rates by state

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

How the 96161 rate is calculated

Each of 96161’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 96161

The CMS indicators that decide how 96161 is paid alongside other services.

96161 compared with similar codes

How to choose

96160Health risk assessmentPatient-focused instrument

Use 96161 when the caregiver completes the health risk instrument for the patient’s benefit. Use 96160 when the patient is the focus of the instrument.

96127Behavioral screening toolPer scored standardized instrument

96127 is a brief emotional or behavioral assessment of the patient. 96161 concerns a caregiver-focused health risk instrument.

96156Health behavior assessmentAssessment or reassessment

96156 describes a health behavior assessment or reassessment. 96161 is specifically for a standardized health risk instrument completed by the caregiver.

Codes related to 96161

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