Billing code 96167: Family interventionMedicare rate & RVUs
Report this service for a timed health behavior intervention focused on the patient’s health needs and delivered with the patient and family together.
Medicare pays $78.16 for 96167 nationally in the office and $63.13 in a hospital or facility. Local office rates run $75.36–$108.78.
Medicare rate · 96167
Family intervention
Swap in your local Medicare rate.
- Work RVUs
- 1.77
- Total RVUs
- 2.34
- Global days
- XXX
National rate · 2026
$78.16
Office setting, before claim adjustments.
See every locality for 96167 → · 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.
On this page 10 sections
What 96167 covers
A clinician works with the patient and one or more family members to address health-related behaviors, coping, adherence, or self-management. The discussion and intervention focus on the patient’s medical condition or health goals, rather than providing family psychotherapy. Physicians and other qualified health care professionals may provide this service in office or facility settings when the patient participates with family members.
Use 96167 for the initial 30 minutes of the family intervention with the patient present. Select it based on the service delivered and documented time, not simply because a family member attended another visit. The record should identify the patient-focused behavioral goal, participating family members, the intervention provided, the patient’s participation, and time spent. For qualifying additional intervention time, report 96168. CMS payment facts list no code-specific payment rules for 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.
Where 96167 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
$75.36 to $108.78
109 of 109 payment localities
96167 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.
$75.36
$108.78
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 | $108.78 | 1 |
| AL | $75.68 | 1 |
| AR | $75.36 | 1 |
| AZ | $77.53 | 1 |
| CA | $80.80–$92.77 | 29 |
| CO | $79.99 | 1 |
| CT | $80.85 | 1 |
| DC | $84.72 | 1 |
| DE | $78.20 | 1 |
| FL | $77.50–$79.44 | 3 |
| GA | $76.20–$78.70 | 2 |
| GU | $80.58 | 1 |
| HI | $80.58 | 1 |
| IA | $76.37 | 1 |
| ID | $76.49 | 1 |
| IL | $76.72–$79.33 | 4 |
| IN | $76.62 | 1 |
| KS | $76.20 | 1 |
| KY | $76.05 | 1 |
| LA | $75.99–$77.10 | 2 |
| MA | $80.03–$84.17 | 2 |
| MD | $78.95–$84.72 | 3 |
| ME | $76.54–$77.87 | 2 |
| MI | $76.57–$77.73 | 2 |
| MN | $78.47 | 1 |
| MO | $75.57–$77.26 | 3 |
| MS | $75.47 | 1 |
| MT | $78.16 | 1 |
| NC | $76.78 | 1 |
| ND | $77.96 | 1 |
| NE | $76.51 | 1 |
| NH | $78.88 | 1 |
| NJ | $82.28–$84.90 | 2 |
| NM | $76.67 | 1 |
| NV | $78.12 | 1 |
| NY | $77.12–$85.76 | 5 |
| OH | $76.53 | 1 |
| OK | $76.08 | 1 |
| OR | $77.98–$81.09 | 2 |
| PA | $76.61–$80.05 | 2 |
| PR | $78.36 | 1 |
| RI | $79.86 | 1 |
| SC | $76.69 | 1 |
| SD | $77.94 | 1 |
| TN | $76.30 | 1 |
| TX | $76.45–$79.32 | 8 |
| UT | $77.00 | 1 |
| VA | $77.74–$84.72 | 2 |
| VI | $78.36 | 1 |
| VT | $77.81 | 1 |
| WA | $79.84–$85.30 | 2 |
| WI | $77.14 | 1 |
| WV | $75.85 | 1 |
| WY | $78.07 | 1 |
How the 96167 rate is calculated
Each of 96167’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 · 96167
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.77Practice expense 0.56Malpractice 0.01
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 96167
96167 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 · 96167
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$78.16
The facility rate would be $63.13 (+$15.03). In a facility, the facility bills its own costs separately.
96167 compared with similar codes
Compare codes
96167 vs 96168 vs 96170 vs 96158 vs 96156: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 96168Family intervention
- 96167 covers the initial 30 minutes of family intervention with the patient present; 96168 reports qualifying additional time.
- 96170Hlth bhv ivntj fam wo pt 1st
- 96170 is for family intervention without the patient present. Patient participation distinguishes 96167.
- 96158Health behavior
- 96158 is an individual health behavior intervention. Choose 96167 when the intervention involves the patient and family together.
- 96156Health behavior assessment
- 96156 covers assessment or reassessment of health behavior. 96167 covers an intervention intended to address the patient’s health-related behavior or needs.
96167 billing questions
When should I use 96167 rather than 96170?
Use 96167 when the patient participates in the family intervention. Use 96170 when the family intervention is conducted without the patient present.
What code reports additional intervention time?
Use 96168 for qualifying additional time beyond the initial 30-minute service. Document the intervention and the time that supports the additional service.
Can I report 96167 for family psychotherapy?
No. The intervention must address the patient’s health behavior or health-related needs; family psychotherapy is a different service.
How does 96167 differ from 96158?
96167 describes a patient-focused intervention involving family with the patient present. 96158 is for an individual health behavior intervention.
What should the note include?
Document the health-related goal, the patient and family members present, the intervention performed, the patient’s involvement, and the time spent.
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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