CPT code 96168: Family intervention, each additional 15 minutes2026 Medicare rate & RVUs in Queens, NY
Report this add-on for each additional 15 minutes of family health behavior intervention conducted with the patient present after the initial service.
In Queens, NY, Medicare pays $31.16 for 96168 in the office and $24.45 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 96168 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 96168 covers
This code represents additional time in a health behavior intervention with the patient and one or more family members or caregivers present. A physician or other qualified health care professional may use the session to help the family support behavior change related to the patient’s health condition, such as following a treatment plan or making health-related lifestyle changes. Sessions may occur in an office or facility setting.
Report this code only with the initial family intervention service, 96167, when the documented service extends beyond its initial time. The record should identify the patient’s health-related concern, the family’s role in the intervention, the work performed, and the time supporting the additional unit or units. CMS classifies 96168 as an add-on code: it is billed only with a primary procedure and paid within that procedure’s global period.
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 Queens, NY compares for 96168
Across 109 of 109 payment localities, the office rate for 96168 runs from $27.24 in Arkansas to $39.22 in Alaska. Queens, NY pays $31.16. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Queens, NY · this page$31.16
- Manhattan, NY · New York$31.07−$0.09
- NYC suburbs and Long Island, NY · New York$31.35+$0.19
- Poughkeepsie and northern NYC suburbs, NY · New York$30.07−$1.09
- Rest of New York · New York$27.94−$3.22
- Los Angeles, CA · California$30.42−$0.74
- Washington, DC area · District of Columbia$30.81−$0.35
Other areas in New York first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| Miami, FLFlorida | $29.19 | $23.28 |
| Chicago, ILIllinois | $29.01 | $23.30 |
| AlaskaAlaska | $39.22 | $33.17 |
| AlabamaAlabama | $27.37 | $22.40 |
| ArkansasArkansas | $27.24 | $22.36 |
| ArizonaArizona | $28.13 | $22.62 |
| Bakersfield, CACalifornia | $29.33 | $23.11 |
| Chico, CACalifornia | $29.27 | $23.04 |
| El Centro, CACalifornia | $29.27 | $23.05 |
| Fresno, CACalifornia | $29.27 | $23.04 |
| Hanford, CACalifornia | $29.27 | $23.04 |
| Madera, CACalifornia | $29.27 | $23.04 |
| Merced, CACalifornia | $29.27 | $23.04 |
| Modesto, CACalifornia | $29.27 | $23.04 |
| Napa, CACalifornia | $31.78 | $24.30 |
| Oxnard, CACalifornia | $30.13 | $23.42 |
| Redding, CACalifornia | $29.27 | $23.04 |
| Rest of CaliforniaCalifornia | $29.27 | $23.04 |
| Riverside, CACalifornia | $29.39 | $23.17 |
| Sacramento, CACalifornia | $30.14 | $23.53 |
| Salinas, CACalifornia | $30.00 | $23.42 |
| San Diego, CACalifornia | $30.24 | $23.45 |
| Marin County, CACalifornia | $33.08 | $25.08 |
| San Francisco, CACalifornia | $33.07 | $25.07 |
| San Benito County, CACalifornia | $33.65 | $25.46 |
| Santa Clara County, CACalifornia | $33.60 | $25.42 |
| San Luis Obispo, CACalifornia | $29.57 | $23.10 |
| Santa Cruz, CACalifornia | $30.19 | $23.29 |
| Santa Maria, CACalifornia | $29.99 | $23.37 |
| Santa Rosa, CACalifornia | $30.47 | $23.49 |
| Stockton, CACalifornia | $29.27 | $23.04 |
| Vallejo, CACalifornia | $31.77 | $24.28 |
| Visalia, CACalifornia | $29.27 | $23.04 |
| Yuba City, CACalifornia | $29.27 | $23.04 |
| ColoradoColorado | $29.02 | $22.98 |
| ConnecticutConnecticut | $29.42 | $23.31 |
| DelawareDelaware | $28.38 | $22.77 |
| Fort Lauderdale, FLFlorida | $28.75 | $23.00 |
| Rest of FloridaFlorida | $28.25 | $22.82 |
| Atlanta, GAGeorgia | $28.63 | $22.86 |
| Rest of GeorgiaGeorgia | $27.70 | $22.63 |
| Hawaii, Guam, HIHawaii | $29.21 | $22.76 |
| IowaIowa | $27.59 | $22.40 |
| IdahoIdaho | $27.65 | $22.43 |
| East St. Louis, ILIllinois | $28.17 | $22.94 |
| Rest of IllinoisIllinois | $27.97 | $22.78 |
| Suburban Chicago, ILIllinois | $28.99 | $23.15 |
| IndianaIndiana | $27.71 | $22.44 |
| KansasKansas | $27.55 | $22.42 |
| KentuckyKentucky | $27.58 | $22.54 |
| New Orleans, LALouisiana | $28.02 | $22.68 |
| Rest of LouisianaLouisiana | $27.57 | $22.54 |
| Metropolitan Boston, MAMassachusetts | $30.58 | $23.80 |
| Rest of MassachusettsMassachusetts | $29.03 | $23.05 |
| Baltimore area, MDMaryland | $29.32 | $23.23 |
| Rest of MarylandMaryland | $28.66 | $22.91 |
| Rest of MaineMaine | $27.70 | $22.48 |
| Southern Maine, MEMaine | $28.20 | $22.58 |
| Detroit, MIMichigan | $28.37 | $22.89 |
| Rest of MichiganMichigan | $27.82 | $22.64 |
| MinnesotaMinnesota | $28.36 | $22.52 |
| Metropolitan Kansas City, MOMissouri | $27.96 | $22.62 |
| Metropolitan St. Louis, MOMissouri | $28.05 | $22.65 |
| Rest of MissouriMissouri | $27.41 | $22.52 |
| MississippiMississippi | $27.33 | $22.44 |
| MontanaMontana | $28.39 | $22.71 |
| North CarolinaNorth Carolina | $27.80 | $22.50 |
| North DakotaNorth Dakota | $28.19 | $22.51 |
| NebraskaNebraska | $27.64 | $22.40 |
| New HampshireNew Hampshire | $28.64 | $22.73 |
| Northern New JerseyNew Jersey | $30.86 | $24.27 |
| Rest of New JerseyNew Jersey | $29.91 | $23.71 |
| New MexicoNew Mexico | $27.88 | $22.67 |
| NevadaNevada | $28.34 | $22.66 |
| OhioOhio | $27.78 | $22.60 |
| OklahomaOklahoma | $27.57 | $22.50 |
| Portland, OROregon | $29.42 | $23.11 |
| Rest of OregonOregon | $28.26 | $22.61 |
| Metropolitan Philadelphia, PAPennsylvania | $29.12 | $23.21 |
| Rest of PennsylvaniaPennsylvania | $27.80 | $22.58 |
| Puerto RicoPuerto Rico | $28.46 | $22.72 |
| Rhode IslandRhode Island | $28.99 | $23.12 |
| South CarolinaSouth Carolina | $27.81 | $22.56 |
| South DakotaSouth Dakota | $28.17 | $22.49 |
| TennesseeTennessee | $27.60 | $22.44 |
| Austin, TXTexas | $28.80 | $22.79 |
| Beaumont, TXTexas | $27.74 | $22.57 |
| Brazoria, TXTexas | $28.42 | $22.80 |
| Dallas, TXTexas | $28.50 | $22.85 |
| Fort Worth, TXTexas | $28.44 | $22.84 |
| Galveston, TXTexas | $28.45 | $22.81 |
| Houston, TXTexas | $28.64 | $23.00 |
| Rest of TexasTexas | $28.00 | $22.61 |
| UtahUtah | $27.94 | $22.60 |
| VirginiaVirginia | $28.17 | $22.59 |
| Virgin Islands, VIUnited States Virgin Islands | $28.46 | $22.72 |
| VermontVermont | $28.16 | $22.53 |
| Rest of WashingtonWashington | $28.96 | $22.98 |
| King County, WAWashington | $30.97 | $24.01 |
| WisconsinWisconsin | $27.87 | $22.43 |
| West VirginiaWest Virginia | $27.62 | $22.68 |
| WyomingWyoming | $28.30 | $22.63 |
96168 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.
$27.24
$39.22
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 | $39.22 | 1 |
| AL | $27.37 | 1 |
| AR | $27.24 | 1 |
| AZ | $28.13 | 1 |
| CA | $29.27–$33.65 | 29 |
| CO | $29.02 | 1 |
| CT | $29.42 | 1 |
| DC | $30.81 | 1 |
| DE | $28.38 | 1 |
| FL | $28.25–$29.19 | 3 |
| GA | $27.70–$28.63 | 2 |
| GU | $29.21 | 1 |
| HI | $29.21 | 1 |
| IA | $27.59 | 1 |
| ID | $27.65 | 1 |
| IL | $27.97–$29.01 | 4 |
| IN | $27.71 | 1 |
| KS | $27.55 | 1 |
| KY | $27.58 | 1 |
| LA | $27.57–$28.02 | 2 |
| MA | $29.03–$30.58 | 2 |
| MD | $28.66–$30.81 | 3 |
| ME | $27.70–$28.20 | 2 |
| MI | $27.82–$28.37 | 2 |
| MN | $28.36 | 1 |
| MO | $27.41–$28.05 | 3 |
| MS | $27.33 | 1 |
| MT | $28.39 | 1 |
| NC | $27.80 | 1 |
| ND | $28.19 | 1 |
| NE | $27.64 | 1 |
| NH | $28.64 | 1 |
| NJ | $29.91–$30.86 | 2 |
| NM | $27.88 | 1 |
| NV | $28.34 | 1 |
| NY | $27.94–$31.35 | 5 |
| OH | $27.78 | 1 |
| OK | $27.57 | 1 |
| OR | $28.26–$29.42 | 2 |
| PA | $27.80–$29.12 | 2 |
| PR | $28.46 | 1 |
| RI | $28.99 | 1 |
| SC | $27.81 | 1 |
| SD | $28.17 | 1 |
| TN | $27.60 | 1 |
| TX | $27.74–$28.80 | 8 |
| UT | $27.94 | 1 |
| VA | $28.17–$30.81 | 2 |
| VI | $28.46 | 1 |
| VT | $28.16 | 1 |
| WA | $28.96–$30.97 | 2 |
| WI | $27.87 | 1 |
| WV | $27.62 | 1 |
| WY | $28.30 | 1 |
How the 96168 rate is calculated
Each of 96168’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 · 96168
RVUs × geographic indexes × conversion factor
Work0.63
0.63 RVUs× 1.000 GPCI
Practice expense0.21
0.21 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
0.8500
Conversion factor
$33.4009
Medicare rate
$28.39
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Queens, NY inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
12,772
- Code
- 96168
- Physician work
- 0.63
- Practice expense
- 0.21
- Malpractice
- 0.01
GPCI2026.csv
81
- Locality
- Queens, NY
- Physician work
- 1.064
- Practice expense
- 1.182
- Malpractice
- 1.442
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.63 | × 1.064 | 0.6703 |
| Practice expense | 0.21 | × 1.182 | 0.2482 |
| Malpractice | 0.01 | × 1.442 | 0.0144 |
| Total RVUs | 0.9330 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Queens, NY$31.16
Office: (0.63 × 1.064 + 0.21 × 1.182 + 0.01 × 1.442) × $33.4009 = $31.16
Facility: (0.63 × 1.064 + 0.04 × 1.182 + 0.01 × 1.442) × $33.4009 = $24.45
Payment rules and modifiers for 96168
The CMS indicators that decide how 96168 is paid alongside other services.
CMS payment indicators · 96168
Family intervention, each additional 15 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 96168 has changed in Queens, NY
96168 · Office / nonfacility
$31.16
Effective 2026-10-01
The base rate is $2.59 higher than on 2025-10-01, moving from $28.57 to $31.16 (9.1%).
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
$28.57changed to$31.16
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.60 changed to 0.63
- Practice expense RVU 0.18 changed to 0.21
- Malpractice RVU 0.02 changed to 0.01
- Work GPCI 1.065 changed to 1.064
- Practice expense GPCI 1.195 changed to 1.182
- Malpractice GPCI 1.462 changed to 1.442
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$27.81changed to$28.57
- Conversion factor 33.2875 changed to 32.3465
- Work RVU 0.58 changed to 0.60
- Practice expense RVU 0.17 changed to 0.18
- Malpractice RVU 0.01 changed to 0.02
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$27.36changed to$27.81
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$27.04changed to$27.36
- Conversion factor 33.8872 changed to 32.7442
- Work RVU 0.55 changed to 0.58
- Practice expense RVU 0.16 changed to 0.17
- Work GPCI 1.061 changed to 1.065
- Practice expense GPCI 1.212 changed to 1.195
- Malpractice GPCI 2.061 changed to 1.462
January 1, 2023
RVU23A
$28.74changed to$27.04
- Conversion factor 34.6062 changed to 33.8872
- Malpractice RVU 0.02 changed to 0.01
- Work GPCI 1.056 changed to 1.061
- Practice expense GPCI 1.228 changed to 1.212
- Malpractice GPCI 2.661 changed to 2.061
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$28.98changed to$28.74
- Conversion factor 34.8931 changed to 34.6062
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$29.22changed to$28.98
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 0.15 changed to 0.16
- Work GPCI 1.054 changed to 1.056
- Practice expense GPCI 1.214 changed to 1.228
- Malpractice GPCI 2.391 changed to 2.661
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
No ratechanged to$29.22
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 | $31.16 | $24.45 | RVU26D |
| 2026-07-01 | $31.16 | $24.45 | RVU26C |
| 2026-04-01 | $31.16 | $24.45 | RVU26B |
| 2026-01-01 | $31.16 | $24.45 | RVU26A |
| 2025-10-01 | $28.57 | $24.71 | RVU25D |
| 2025-07-01 | $28.57 | $24.71 | RVU25C |
| 2025-04-01 | $28.57 | $24.71 | RVU25B |
| 2025-01-01 | $28.57 | $24.71 | RVU25A |
| 2024-10-01 | $27.81 | $23.83 | RVU24D |
| 2024-07-01 | $27.81 | $23.83 | RVU24C |
| 2024-04-01 | $27.81 | $23.83 | RVU24B |
| 2024-03-09 | $27.81 | $23.83 | RVU24AR |
| 2024-01-01 | $27.36 | $23.44 | RVU24A |
| 2023-10-01 | $27.04 | $23.35 | RVU23D |
| 2023-07-01 | $27.04 | $23.35 | RVU23C |
| 2023-04-01 | $27.04 | $23.35 | RVU23B |
| 2023-01-01 | $27.04 | $23.35 | RVU23A |
| 2022-10-01 | $28.74 | $24.92 | RVU22D |
| 2022-07-01 | $28.74 | $24.92 | RVU22C |
| 2022-04-01 | $28.74 | $24.92 | RVU22B |
| 2022-01-01 | $28.74 | $24.92 | RVU22A |
| 2021-10-01 | $28.98 | $25.12 | RVU21D |
| 2021-07-01 | $28.98 | $25.12 | RVU21C |
| 2021-04-01 | $28.98 | $25.12 | RVU21B |
| 2021-01-01 | $28.98 | $25.12 | RVU21A |
| 2020-10-01 | $29.22 | $26.15 | RVU20D |
| 2020-07-01 | $29.22 | $26.15 | RVU20C |
| 2020-04-01 | $29.22 | $26.15 | RVU20B |
| 2020-01-01 | $29.22 | $26.15 | 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 Queens, NY rate applies
Queens, NY is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in New York. Some span more than one payment area; confirm with the service ZIP.
- 96168 in New York · multiple payment areas
96168 billing questions
When is 96168 reported with 96167?
Use 96167 for the initial family intervention and 96168 for each additional 15 minutes of qualifying intervention time. The patient must be present for this family-service code.
Can 96168 be billed by itself?
No. It is an add-on code and must be reported with its primary family intervention service, 96167.
How does 96168 differ from 96171?
96168 is for additional family intervention time with the patient present. 96171 is for additional family intervention time when the patient is not present.
What should the documentation support?
Document the health behavior concern, the patient’s presence, the family’s participation, the intervention provided, and the time supporting the additional service.
Can 96168 be used for an individual session?
No. For additional health behavior intervention time provided individually to the patient, consider 96159 rather than this family-service add-on.
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
Fee sheets · Coming soon
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