CPT code 96161: Health risk assessment, caregiver-focused instrument2026 Medicare rate & RVUs in Texas
Report a scored, documented standardized health risk instrument completed by a caregiver to identify risks relevant to the patient’s care.
Medicare pays $3.04–$3.53 for 96161 in the office in Texas, from Beaumont, TX to Austin, TX. 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 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 in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$3.04 to $3.53
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | $3.53 | Unavailable |
| Beaumont, TX | $3.04 | Unavailable |
| Brazoria, TX | $3.31 | Unavailable |
| Dallas, TX | $3.33 | Unavailable |
| Fort Worth, TX | $3.29 | Unavailable |
| Galveston, TX | $3.32 | Unavailable |
| Houston, TX | $3.32 | Unavailable |
| Rest of Texas | $3.17 | Unavailable |
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.
How the rate is built · 96161
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.10
0.10 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
0.1000
Conversion factor
$33.4009
Medicare rate
$3.34
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 96161
The CMS indicators that decide how 96161 is paid alongside other services.
CMS payment indicators · 96161
Health risk assessment, caregiver-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. |
96161 compared with similar codes
Compare codes · National
4 codes, side by side
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.
96161 billing questions
How is 96161 different from 96160?
96161 is for a health risk instrument completed by the caregiver for the patient’s benefit. 96160 is for an instrument focused on the patient.
Can 96161 be submitted by itself?
No. CMS identifies it as an add-on code, so the claim must include a primary procedure.
Does the caregiver have to complete a standardized instrument?
Yes. The service requires a caregiver-focused standardized health risk instrument, with scoring and documentation.
What documentation supports reporting 96161?
Document the instrument, the caregiver who completed it, the score or result, and how the information relates to the patient’s care.
Can practice staff perform this service?
It may be billed as an incident-to service only when performed under physician supervision.
Is 96161’s payment separate from the primary procedure’s global period?
CMS places payment for this add-on within the primary procedure’s global period.
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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