CPT code 96164: Group intervention, first 30 minutes2026 Medicare rate & RVUs in Maryland
Report 96164 for the initial 30 minutes of face-to-face group intervention addressing behavioral factors that affect patients’ physical health or treatment.
Medicare pays $11.78–$12.76 for 96164 in the office in Maryland, from Rest of Maryland to Washington, DC area. 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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What 96164 covers
Code 96164 represents face-to-face health behavior intervention delivered to a group of at least two patients. A physician or other qualified health care professional works with the group on behavioral, psychological, social, or lifestyle factors affecting physical health or adherence to medical treatment. For example, patients with a chronic condition may receive group support for barriers to following a treatment plan. This is an intervention, not simply a group screening or assessment.
Report 96164 for the initial 30 minutes of the group service. The record should identify the health-related behavioral needs addressed, the intervention provided, the participants, and the time spent. Use 96165 for qualifying additional time. CMS fee-schedule valuation includes physician work, practice expense, and malpractice; the practice-expense value differs between 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 96164 pays more and less in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$11.78 to $12.76
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | $12.14 | $9.63 |
| Rest of Maryland | $11.78 | $9.42 |
| Washington, DC area | $12.76 | $10.00 |
How the 96164 rate is calculated
Each of 96164’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 · 96164
RVUs × geographic indexes × conversion factor
Work0.24
0.24 RVUs× 1.000 GPCI
Practice expense0.10
0.10 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
0.3500
Conversion factor
$33.4009
Medicare rate
$11.69
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 96164
96164 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 96164
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$11.69
- Non-facility (office)
- $11.69
- Facility
- $9.35
Higher because the practice carries its own overhead.
96164 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 96165Group interventionEach additional 30 minutes
- 96164 covers the initial 30 minutes of group intervention; 96165 is the add-on for qualifying additional time.
- 96158Health behaviorIndividual, initial 30 minutes
- 96158 is for individual health behavior intervention. Choose 96164 when at least two patients receive the intervention as a group.
- 96167Family interventionPatient present, initial 30 minutes
- 96167 is for family intervention with the patient participating, not a group intervention for multiple patients.
- 96156Health behavior assessmentAssessment or reassessment
- 96156 covers health behavior assessment or reassessment. Use 96164 for face-to-face group intervention rather than assessment.
96164 billing questions
When should 96164 be used instead of 96158?
Use 96164 when the intervention is delivered to a group of at least two patients. Use 96158 for an individual health behavior intervention.
What does 96164 include?
It covers the initial 30 minutes of face-to-face group intervention focused on behavioral factors affecting physical health or medical treatment. Document the intervention and time, rather than reporting a group assessment as treatment.
How is additional group-intervention time reported?
Use 96165 for qualifying additional time beyond the initial service. Record the time spent so the initial and additional services are supported.
Can 96164 be used for a family session?
Use the family-intervention codes when the service is family-focused. Code 96167 describes the initial service when the patient participates; 96170 is for family intervention without the patient.
What documentation supports 96164?
Document the group participants, the health-related behavioral issue addressed, the intervention performed, and the face-to-face time. The note should show how the intervention relates to physical health or treatment.
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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