CPT code 96164: Group intervention, first 30 minutes2026 Medicare rate & RVUs in Wisconsin

In Wisconsin, Medicare pays $11.32 for 96164 in the office and $9.08 when it’s performed in a hospital or facility.

Check a contract rate as a % of Medicare · 96164 nationwide

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

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.

How Wisconsin compares for 96164

Across 109 of 109 payment localities, the office rate for 96164 runs from $11.06 in Arkansas to $15.77 in Alaska. Wisconsin pays $11.32. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

96164 rates by state

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

See 96164 in every payment locality

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.

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.

Codes related to 96164

Related codes aren’t interchangeable: bill the code that matches the service performed.

How 96164 has changed in Wisconsin

Price 96164 for an earlier date of service

Where the Wisconsin rate applies

Wisconsin is a Medicare payment area, not a city. Our Census mapping connects it to 807 cities and communities in Wisconsin. Some span more than one payment area; confirm with the service ZIP.

• Abbotsford
• Abrams
• Adams
• Adell
• Albany
• Algoma
• Allens Grove
• Allenton

Browse all communities in Wisconsin

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