CPT code 96165: Group intervention, each additional 30 minutes2026 Medicare rate & RVUs in New Mexico
Report 96165 for each additional 30-minute segment of a health behavior intervention delivered face-to-face to a group of patients.
In New Mexico, Medicare pays $4.90 for 96165 in the office and $3.98 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 96165 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 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.
How New Mexico compares for 96165
Across 109 of 109 payment localities, the office rate for 96165 runs from $4.82 in Arkansas to $6.93 in Alaska. New Mexico pays $4.90. The RVUs are the same everywhere; the geographic indexes change the dollars.
- New Mexico · this page$4.90
- Los Angeles, CA · California$5.41+$0.51
- Washington, DC area · District of Columbia$5.45+$0.55
- Miami, FL · Florida$5.06+$0.16
- Chicago, IL · Illinois$5.04+$0.14
- Manhattan, NY · New York$5.46+$0.56
- Alaska · Alaska$6.93+$2.03
Other areas in New Mexico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $4.84 | $3.97 |
| ArkansasArkansas | $4.82 | $3.96 |
| ArizonaArizona | $4.97 | $4.00 |
| Bakersfield, CACalifornia | $5.21 | $4.11 |
| Chico, CACalifornia | $5.20 | $4.10 |
| El Centro, CACalifornia | $5.20 | $4.10 |
| Fresno, CACalifornia | $5.20 | $4.10 |
| Hanford, CACalifornia | $5.20 | $4.10 |
| Madera, CACalifornia | $5.20 | $4.10 |
| Merced, CACalifornia | $5.20 | $4.10 |
| Modesto, CACalifornia | $5.20 | $4.10 |
| Napa, CACalifornia | $5.67 | $4.35 |
| Oxnard, CACalifornia | $5.36 | $4.17 |
| Redding, CACalifornia | $5.20 | $4.10 |
| Rest of CaliforniaCalifornia | $5.20 | $4.10 |
| Riverside, CACalifornia | $5.20 | $4.11 |
| Sacramento, CACalifornia | $5.36 | $4.19 |
| Salinas, CACalifornia | $5.34 | $4.18 |
| San Diego, CACalifornia | $5.38 | $4.18 |
| Marin County, CACalifornia | $5.91 | $4.49 |
| San Francisco, CACalifornia | $5.91 | $4.49 |
| San Benito County, CACalifornia | $6.00 | $4.56 |
| Santa Clara County, CACalifornia | $6.00 | $4.56 |
| San Luis Obispo, CACalifornia | $5.26 | $4.12 |
| Santa Cruz, CACalifornia | $5.37 | $4.16 |
| Santa Maria, CACalifornia | $5.33 | $4.17 |
| Santa Rosa, CACalifornia | $5.42 | $4.19 |
| Stockton, CACalifornia | $5.20 | $4.10 |
| Vallejo, CACalifornia | $5.67 | $4.35 |
| Visalia, CACalifornia | $5.20 | $4.10 |
| Yuba City, CACalifornia | $5.20 | $4.10 |
| ColoradoColorado | $5.14 | $4.07 |
| ConnecticutConnecticut | $5.19 | $4.11 |
| DelawareDelaware | $5.01 | $4.02 |
| Fort Lauderdale, FLFlorida | $5.03 | $4.01 |
| Rest of FloridaFlorida | $4.95 | $3.99 |
| Atlanta, GAGeorgia | $5.04 | $4.02 |
| Rest of GeorgiaGeorgia | $4.87 | $3.97 |
| Hawaii, Guam, HIHawaii | $5.19 | $4.05 |
| IowaIowa | $4.90 | $3.98 |
| IdahoIdaho | $4.90 | $3.98 |
| East St. Louis, ILIllinois | $4.90 | $3.98 |
| Rest of IllinoisIllinois | $4.89 | $3.98 |
| Suburban Chicago, ILIllinois | $5.07 | $4.04 |
| IndianaIndiana | $4.91 | $3.98 |
| KansasKansas | $4.88 | $3.98 |
| KentuckyKentucky | $4.86 | $3.97 |
| New Orleans, LALouisiana | $4.93 | $3.99 |
| Rest of LouisianaLouisiana | $4.86 | $3.97 |
| Metropolitan Boston, MAMassachusetts | $5.42 | $4.22 |
| Rest of MassachusettsMassachusetts | $5.14 | $4.08 |
| Baltimore area, MDMaryland | $5.17 | $4.09 |
| Rest of MarylandMaryland | $5.06 | $4.05 |
| Rest of MaineMaine | $4.90 | $3.98 |
| Southern Maine, MEMaine | $5.00 | $4.01 |
| Detroit, MIMichigan | $4.96 | $4.00 |
| Rest of MichiganMichigan | $4.89 | $3.98 |
| MinnesotaMinnesota | $5.05 | $4.02 |
| Metropolitan Kansas City, MOMissouri | $4.93 | $3.99 |
| Metropolitan St. Louis, MOMissouri | $4.95 | $3.99 |
| Rest of MissouriMissouri | $4.83 | $3.96 |
| MississippiMississippi | $4.82 | $3.96 |
| MontanaMontana | $5.01 | $4.01 |
| North CarolinaNorth Carolina | $4.92 | $3.99 |
| North DakotaNorth Dakota | $5.01 | $4.01 |
| NebraskaNebraska | $4.91 | $3.98 |
| New HampshireNew Hampshire | $5.06 | $4.02 |
| Northern New JerseyNew Jersey | $5.46 | $4.29 |
| Rest of New JerseyNew Jersey | $5.28 | $4.19 |
| NevadaNevada | $5.01 | $4.01 |
| NYC suburbs and Long Island, NYNew York | $5.50 | $4.31 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $5.30 | $4.21 |
| Queens, NYNew York | $5.49 | $4.30 |
| Rest of New YorkNew York | $4.94 | $3.99 |
| OhioOhio | $4.89 | $3.98 |
| OklahomaOklahoma | $4.87 | $3.97 |
| Portland, OROregon | $5.22 | $4.10 |
| Rest of OregonOregon | $5.00 | $4.01 |
| Metropolitan Philadelphia, PAPennsylvania | $5.13 | $4.09 |
| Rest of PennsylvaniaPennsylvania | $4.90 | $3.98 |
| Puerto RicoPuerto Rico | $5.02 | $4.01 |
| Rhode IslandRhode Island | $5.12 | $4.09 |
| South CarolinaSouth Carolina | $4.91 | $3.98 |
| South DakotaSouth Dakota | $5.01 | $4.01 |
| TennesseeTennessee | $4.89 | $3.98 |
| Austin, TXTexas | $5.09 | $4.03 |
| Beaumont, TXTexas | $4.89 | $3.98 |
| Brazoria, TXTexas | $5.03 | $4.03 |
| Dallas, TXTexas | $5.04 | $4.04 |
| Fort Worth, TXTexas | $5.02 | $4.04 |
| Galveston, TXTexas | $5.03 | $4.04 |
| Houston, TXTexas | $5.03 | $4.04 |
| Rest of TexasTexas | $4.94 | $3.99 |
| UtahUtah | $4.93 | $3.99 |
| VirginiaVirginia | $4.99 | $4.00 |
| Virgin Islands, VIUnited States Virgin Islands | $5.02 | $4.01 |
| VermontVermont | $5.00 | $4.00 |
| Rest of WashingtonWashington | $5.13 | $4.07 |
| King County, WAWashington | $5.50 | $4.27 |
| WisconsinWisconsin | $4.95 | $3.99 |
| West VirginiaWest Virginia | $4.84 | $3.96 |
| WyomingWyoming | $5.01 | $4.01 |
96165 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
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.
The exact New Mexico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
12,770
- Code
- 96165
- Physician work
- 0.11
- Practice expense
- 0.04
- Malpractice
- 0.00
GPCI2026.csv
77
- Locality
- New Mexico
- Physician work
- 1.000
- Practice expense
- 0.917
- Malpractice
- 1.201
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.11 | × 1.000 | 0.1100 |
| Practice expense | 0.04 | × 0.917 | 0.0367 |
| Malpractice | 0.00 | × 1.201 | 0.0000 |
| Total RVUs | 0.1467 | ||
| Conversion factor | × 33.4009 | ||
Office rate, New Mexico$4.90
Office: (0.11 × 1 + 0.04 × 0.917 + 0 × 1.201) × $33.4009 = $4.90
Facility: (0.11 × 1 + 0.01 × 0.917 + 0 × 1.201) × $33.4009 = $3.98
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. |
How 96165 has changed in New Mexico
96165 · Office / nonfacility
$4.90
Effective 2026-10-01
The base rate is $0.17 higher than on 2025-10-01, moving from $4.73 to $4.90 (3.6%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$4.73changed to$4.90
- Conversion factor 32.3465 changed to 33.4009
- Practice expense GPCI 0.908 changed to 0.917
- Malpractice GPCI 1.172 changed to 1.201
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$4.54changed to$4.73
- Conversion factor 33.2875 changed to 32.3465
- Work RVU 0.10 changed to 0.11
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$4.46changed to$4.54
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$4.31changed to$4.46
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 0.03 changed to 0.04
- Practice expense GPCI 0.902 changed to 0.908
- Malpractice GPCI 1.169 changed to 1.172
January 1, 2023
RVU23A
$4.39changed to$4.31
- Conversion factor 34.6062 changed to 33.8872
- Practice expense GPCI 0.896 changed to 0.902
- Malpractice GPCI 1.166 changed to 1.169
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$4.43changed to$4.39
- Conversion factor 34.8931 changed to 34.6062
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$4.59changed to$4.43
- Conversion factor 36.0896 changed to 34.8931
- Practice expense GPCI 0.908 changed to 0.896
- Malpractice GPCI 1.207 changed to 1.166
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
No ratechanged to$4.59
Held through RVU20B, RVU20C, RVU20D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1, RVU18B, RVU18C, RVU18D, RVU19A, RVU19B, RVU19C, RVU19D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $4.90 | $3.98 | RVU26D |
| 2026-07-01 | $4.90 | $3.98 | RVU26C |
| 2026-04-01 | $4.90 | $3.98 | RVU26B |
| 2026-01-01 | $4.90 | $3.98 | RVU26A |
| 2025-10-01 | $4.73 | $4.15 | RVU25D |
| 2025-07-01 | $4.73 | $4.15 | RVU25C |
| 2025-04-01 | $4.73 | $4.15 | RVU25B |
| 2025-01-01 | $4.73 | $4.15 | RVU25A |
| 2024-10-01 | $4.54 | $3.93 | RVU24D |
| 2024-07-01 | $4.54 | $3.93 | RVU24C |
| 2024-04-01 | $4.54 | $3.93 | RVU24B |
| 2024-03-09 | $4.54 | $3.93 | RVU24AR |
| 2024-01-01 | $4.46 | $3.87 | RVU24A |
| 2023-10-01 | $4.31 | $4.00 | RVU23D |
| 2023-07-01 | $4.31 | $4.00 | RVU23C |
| 2023-04-01 | $4.31 | $4.00 | RVU23B |
| 2023-01-01 | $4.31 | $4.00 | RVU23A |
| 2022-10-01 | $4.39 | $4.08 | RVU22D |
| 2022-07-01 | $4.39 | $4.08 | RVU22C |
| 2022-04-01 | $4.39 | $4.08 | RVU22B |
| 2022-01-01 | $4.39 | $4.08 | RVU22A |
| 2021-10-01 | $4.43 | $3.80 | RVU21D |
| 2021-07-01 | $4.43 | $3.80 | RVU21C |
| 2021-04-01 | $4.43 | $3.80 | RVU21B |
| 2021-01-01 | $4.43 | $3.80 | RVU21A |
| 2020-10-01 | $4.59 | $3.94 | RVU20D |
| 2020-07-01 | $4.59 | $3.94 | RVU20C |
| 2020-04-01 | $4.59 | $3.94 | RVU20B |
| 2020-01-01 | $4.59 | $3.94 | RVU20A |
| 2019-10-01 | Not in this release | Not in this release | RVU19D |
| 2019-07-01 | Not in this release | Not in this release | RVU19C |
| 2019-04-01 | Not in this release | Not in this release | RVU19B |
| 2019-01-01 | Not in this release | Not in this release | RVU19A |
| 2018-10-01 | Not in this release | Not in this release | RVU18D |
| 2018-07-01 | Not in this release | Not in this release | RVU18C |
| 2018-04-01 | Not in this release | Not in this release | RVU18B |
| 2018-01-01 | Not in this release | Not in this release | RVU18AR1 |
| 2017-10-01 | Not in this release | Not in this release | RVU17D |
| 2017-07-01 | Not in this release | Not in this release | RVU17C |
| 2017-04-01 | Not in this release | Not in this release | RVU17B |
| 2017-01-01 | Not in this release | Not in this release | RVU17A |
| 2016-10-01 | Not in this release | Not in this release | RVU16D |
| 2016-07-01 | Not in this release | Not in this release | RVU16C |
| 2016-04-01 | Not in this release | Not in this release | RVU16B |
| 2016-01-01 | Not in this release | Not in this release | RVU16A |
| 2015-10-01 | Not in this release | Not in this release | RVU15D |
| 2015-07-01 | Not in this release | Not in this release | RVU15C |
| 2015-04-01 | Not in this release | Not in this release | RVU15B |
| 2015-01-01 | Not in this release | Not in this release | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the New Mexico rate applies
New Mexico is a Medicare payment area, not a city. Our Census mapping connects it to 528 cities and communities in New Mexico. Some span more than one payment area; confirm with the service ZIP.
- Abeytas
- Abiquiu
- Acomita Lake
- Adelino
- Agua Fria
- Alamillo
- Alamo
- Alamogordo
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
Show the CMS file lines behind this rate
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