CPT code 96170: Family intervention, patient absent2026 Medicare rate & RVUs in Guam
Family-focused health behavior intervention reported when a clinician works with family members without the patient present to support the patient’s physical health care.
CMS doesn’t publish an office rate for 96170 in Guam.
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 96170 covers
This service covers face-to-face work with a patient’s family members, without the patient present, to address behavioral, emotional, cognitive, or social factors affecting the patient’s physical health or treatment. A qualified health care professional may use the session to help family members support care plans, health-related behavior changes, or management of a medical condition. It is an intervention, not a health behavior assessment or a session delivered to the patient individually.
Code 96170 represents the initial 30 minutes; 96171 is used for each additional 15 minutes of this family intervention. Select the family code that matches whether the patient is present: 96170 is for the patient-absent format, while 96167 is the initial family service with the patient present. Medicare physician fee schedule status N means Medicare does not cover this service.
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.
96170 in Hawaii, Guam, HI
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam, HI | Unavailable | Unavailable |
How the 96170 rate is calculated
Each of 96170’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 · 96170
RVUs × geographic indexes × conversion factor
Work1.50
1.50 RVUs× 1.000 GPCI
Practice expense0.66
0.66 RVUs× 1.000 GPCI
Malpractice0.08
0.08 RVUs× 1.000 GPCI
Adjusted RVUs
2.2400
Conversion factor
$33.4009
Medicare rate
$74.82
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 96170
96170 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 · 96170
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
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96170 isn’t priced in this setting.
96170 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 96167Family interventionPatient present, initial 30 minutes
- Both are initial family health behavior interventions. Use 96170 when the patient is absent and 96167 when the patient is present.
- 96168Family interventionEach additional 15 minutes
- 96168 reports additional time for a family intervention with the patient present; 96170 is the initial service when the patient is absent.
- 96171Family interventionWithout patient, each 15 minutes
- 96171 reports additional 15-minute intervals after the initial patient-absent family intervention; 96170 represents its initial 30 minutes.
- 96158Health behaviorIndividual, initial 30 minutes
- 96158 is an initial individual intervention with the patient, rather than a family intervention conducted without the patient.
96170 billing questions
Does the patient attend a 96170 session?
No. The family intervention is provided without the patient present; use the family code for a session with the patient present when that describes the encounter.
How does 96170 differ from 96167?
Both describe an initial family health behavior intervention. Choose 96170 when the patient is absent and 96167 when the patient is present.
What code reports additional time after 96170?
Use 96171 for each additional 15 minutes of the family intervention without the patient present.
Can 96170 be used for an individual session with the patient?
No. It describes work with family members while the patient is absent; 96158 is the initial individual health behavior intervention code.
Does Medicare cover 96170?
No. Medicare physician fee schedule status N identifies this service as not covered by Medicare.
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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