CPT code 97156: Family guidance, adaptive behavior2026 Medicare rate & RVUs in Massachusetts
A physician or qualified health care professional provides face-to-face adaptive behavior guidance to a patient’s family or caregiver, with or without the patient present.
CMS doesn’t publish an office rate for 97156 in Massachusetts.
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 97156 covers
97156 covers face-to-face adaptive behavior treatment guidance provided by a physician or other qualified health care professional to a patient’s guardian or caregiver. The guidance may help the family apply treatment strategies in the patient’s daily routines and support the behavior plan. The patient may be present or absent; this service is distinct from direct adaptive behavior treatment delivered to the patient and from guidance provided to multiple families together.
For Medicare physician fee schedule purposes, 97156 has status C, or carrier priced: CMS publishes no national payment, and the Medicare Administrative Contractor sets payment for each claim. Report the service in 15-minute units. The reported time is for face-to-face guidance with the guardian or caregiver, rather than time spent providing direct adaptive behavior treatment to the patient.
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 97156 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston, MA | Unavailable | Unavailable |
| Rest of Massachusetts | Unavailable | Unavailable |
How the 97156 rate is calculated
Each of 97156’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 · 97156
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.00
0.00 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
0.0000
Conversion factor
$33.4009
Medicare rate
$0.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 97156
97156 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 · 97156
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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97156 isn’t priced in this setting.
97156 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 97157Family behavior guidanceMultiple-family group
- 97156 is caregiver guidance for one patient’s family. 97157 is used when guidance involves multiple families.
- 97155Behavior treatmentProtocol modification
- 97155 describes clinician-delivered adaptive behavior treatment with protocol modification. 97156 is guidance for a caregiver, with or without the patient present.
- 97153Adaptive behavior treatmentOne patient, technician
- 97153 is adaptive behavior treatment delivered to the patient by a technician. 97156 is face-to-face guidance for the caregiver by a physician or qualified health care professional.
- 97151Behavior assessmentPhysician or QHP
- 97151 is an adaptive behavior assessment. 97156 is caregiver guidance, not assessment.
97156 billing questions
Does the patient attend the 97156 session?
The patient may be present or absent. The service is face-to-face adaptive behavior guidance with the guardian or caregiver.
How many minutes does one unit represent?
One unit represents 15 minutes of caregiver guidance.
How does 97156 differ from 97157?
97156 is guidance for a patient’s family or caregiver. 97157 is guidance involving multiple families.
When would 97155 be a better fit?
Use 97155 for adaptive behavior treatment with protocol modification by a physician or qualified health care professional. 97156 describes guidance for a guardian or caregiver.
What should the record support?
Document the face-to-face caregiver session, its duration, and the adaptive behavior guidance provided.
How does Medicare price 97156?
The code has physician fee schedule status C, or carrier priced. CMS publishes no national payment, and the Medicare Administrative Contractor sets payment for each claim.
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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