CPT code 96165: Group intervention, each additional 30 minutes2026 Medicare rate & RVUs
Report 96165 for each additional 30-minute segment of a health behavior intervention delivered face-to-face to a group of patients.
Medicare pays $5.01 for 96165 nationally in the office and $4.01 in a hospital or facility. Local office rates run $4.82–$6.93.
Medicare rate · 96165
Group intervention, each additional 30 minutes
- Work RVUs
- 0.11
- Total RVUs
- 0.15
- Global days
- ZZZ
National rate · 2026
$5.01
Office setting, before claim adjustments.
See every locality for 96165 →Billed by an NP, PA or therapist? →
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 10 sections
What 96165 covers
A physician or other qualified health care professional uses this add-on service to address behavioral, emotional, social, or cognitive factors affecting patients’ physical health and treatment. In a group session, participants receive intervention directed toward health-related goals such as improving self-management or supporting adherence to a treatment plan. The service may be provided in an office or facility; the group format, rather than an individual or family session, distinguishes it from related intervention services.
Report 96165 only with the primary group intervention code 96164, for additional intervention time beyond the initial segment. Documentation should identify the health-related behavioral goals, the intervention provided, the group format, and the time supporting the additional segment. CMS classifies 96165 as an add-on code: it is billed only with a primary procedure and paid within that procedure’s global period. It is not a stand-alone report for a group session.
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 96165 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$4.82 to $6.93
109 of 109 payment localities
96165 rates by state
Office rate range in each state. Select a state to see its payment localities.
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Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$4.82
$6.93
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $6.93 | 1 |
| AL | $4.84 | 1 |
| AR | $4.82 | 1 |
| AZ | $4.97 | 1 |
| CA | $5.20–$6.00 | 29 |
| CO | $5.14 | 1 |
| CT | $5.19 | 1 |
| DC | $5.45 | 1 |
| DE | $5.01 | 1 |
| FL | $4.95–$5.06 | 3 |
| GA | $4.87–$5.04 | 2 |
| GU | $5.19 | 1 |
| HI | $5.19 | 1 |
| IA | $4.90 | 1 |
| ID | $4.90 | 1 |
| IL | $4.89–$5.07 | 4 |
| IN | $4.91 | 1 |
| KS | $4.88 | 1 |
| KY | $4.86 | 1 |
| LA | $4.86–$4.93 | 2 |
| MA | $5.14–$5.42 | 2 |
| MD | $5.06–$5.45 | 3 |
| ME | $4.90–$5.00 | 2 |
| MI | $4.89–$4.96 | 2 |
| MN | $5.05 | 1 |
| MO | $4.83–$4.95 | 3 |
| MS | $4.82 | 1 |
| MT | $5.01 | 1 |
| NC | $4.92 | 1 |
| ND | $5.01 | 1 |
| NE | $4.91 | 1 |
| NH | $5.06 | 1 |
| NJ | $5.28–$5.46 | 2 |
| NM | $4.90 | 1 |
| NV | $5.01 | 1 |
| NY | $4.94–$5.50 | 5 |
| OH | $4.89 | 1 |
| OK | $4.87 | 1 |
| OR | $5.00–$5.22 | 2 |
| PA | $4.90–$5.13 | 2 |
| PR | $5.02 | 1 |
| RI | $5.12 | 1 |
| SC | $4.91 | 1 |
| SD | $5.01 | 1 |
| TN | $4.89 | 1 |
| TX | $4.89–$5.09 | 8 |
| UT | $4.93 | 1 |
| VA | $4.99–$5.45 | 2 |
| VI | $5.02 | 1 |
| VT | $5.00 | 1 |
| WA | $5.13–$5.50 | 2 |
| WI | $4.95 | 1 |
| WV | $4.84 | 1 |
| WY | $5.01 | 1 |
How the 96165 rate is calculated
Each of 96165’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 · 96165
RVUs × geographic indexes × conversion factor
Work0.11
0.11 RVUs× 1.000 GPCI
Practice expense0.04
0.04 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
0.1500
Conversion factor
$33.4009
Medicare rate
$5.01
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 96165
The CMS indicators that decide how 96165 is paid alongside other services.
CMS payment indicators · 96165
Group intervention, each additional 30 minutes
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
96165 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 96164Group interventionFirst 30 minutes
- 96164 covers the initial group intervention segment; 96165 is reserved for additional time and must accompany 96164.
- 96159Health behavior interventionIndividual, additional time
- 96159 is for additional individual intervention time with one patient; 96165 is for additional time in a group session.
- 96168Family interventionEach additional 15 minutes
- 96168 covers additional time in a family intervention session, while 96165 applies to a group intervention session.
96165 billing questions
Can 96165 be reported by itself?
No. It is an add-on code and must be reported with the primary group intervention code 96164.
How is 96165 different from 96164?
96164 reports the initial group intervention segment; 96165 reports each additional 30-minute segment.
When should the individual intervention codes be used instead?
Use 96158 and 96159 when the health behavior intervention is delivered to one patient rather than a group.
What should the note support?
Document the health-related behavioral goals, the intervention delivered, that it was a group session, and the time supporting the additional segment.
Can 96165 be used for a family intervention?
No. Family intervention services are reported with the family-session code family, such as 96167 and 96168, rather than the group codes.
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
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