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CMS RVU26D · Effective 2026-10-01

96156 in Modesto

Office / nonfacility

$111.17

Base rate per service

Facility setting

$88.47

Base rate per service

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

Health behavior services

About 96156: Health behavior assessment or reassessment

Report 96156 for a health-focused assessment of behavioral factors affecting a patient's physical condition, treatment adherence, or health outcomes.

96156 covers a health-focused clinical interview, behavioral observations, and clinical decision-making to assess how a patient's behavior and other personal factors relate to physical health. Physicians and other qualified health professionals may perform it in settings such as primary care or specialty clinics for patients managing conditions such as diabetes, chronic pain, or obesity. The focus is the connection between behavior and physical health, rather than psychotherapy or psychological testing.

Choose the code when the encounter consists of assessment or reassessment, not active behavioral intervention. Document the health condition or concern, relevant behavioral factors, assessment findings, and resulting clinical decisions. The service is not selected in timed increments; elapsed minutes alone do not establish additional units. CMS assigns physician work and practice-expense relative values, with practice-expense inputs differing between office and facility settings.

Where the value comes from

  • Work RVU2.40 · 75%
  • Practice expense (office) RVU0.80 · 25%
  • Malpractice RVU0.02 · 1%

20.4K

Medicare services in 2024 · #1139 by national volume

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.

96156 compared with similar codes

Office rates for Modesto, from the same CMS release.

96158

Health behavior

Individual, initial 30 minutes

$76.34

96156 assesses behavioral factors affecting physical health; 96158 reports individual intervention addressing health behavior.

96127

Behavioral screening tool

Per scored standardized instrument

$5.30

96127 is for a brief emotional or behavioral assessment. 96156 describes a health-focused assessment or reassessment tied to physical health.

96160

Health risk assessment

Patient-focused instrument

$3.29

96160 is a patient-focused health risk assessment; 96156 involves clinical assessment of behavior in relation to a health condition or concern.

96130

Psychological evaluation

First hour

$127.38

96130 reports psychological test evaluation, including interpretation and clinical integration. 96156 is a health behavior assessment, not psychological test evaluation.

The same code, a different location

How does Modesto compare?

In Bakersfield, the office rate for 96156 is $111.38—$0.21 higher than the $111.17 rate in Modesto. Both use the same code, release and participation basis.

96156 across payment areas

Same release and payment basis · bars start at $0

  1. Modesto · This locality

    $111.17

  2. Bakersfield

    $111.38

    $0.21 higher than Modesto

  3. Chico

    $111.17

    The same base rate than Modesto

  4. El Centro

    $111.17

    The same base rate than Modesto

  5. Fresno

    $111.17

    The same base rate than Modesto

  6. Hanford-Corcoran

    $111.17

    The same base rate than Modesto

  7. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $115.50

    $4.33 higher than Modesto

Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 96156 ranges from $103.46 in Arkansas to $149.07 in Alaska*. This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Madera

    California · 96156

    Office

    $111.17

    Facility

    $88.47

    The same base rate than Modesto for the office setting.

  • Merced

    California · 96156

    Office

    $111.17

    Facility

    $88.47

    The same base rate than Modesto for the office setting.

  • Napa

    California · 96156

    Office

    $120.77

    Facility

    $93.48

    $9.60 higher than Modesto for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 96156

    Office

    $114.41

    Facility

    $89.93

    $3.24 higher than Modesto for the office setting.

  • Redding

    California · 96156

    Office

    $111.17

    Facility

    $88.47

    The same base rate than Modesto for the office setting.

  • Rest Of California

    California · 96156

    Office

    $111.17

    Facility

    $88.47

    The same base rate than Modesto for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 96156

    Office

    $111.46

    Facility

    $88.76

    $0.29 higher than Modesto for the office setting.

  • Sacramento-Roseville-Folsom

    California · 96156

    Office

    $114.48

    Facility

    $90.40

    $3.31 higher than Modesto for the office setting.

  • Salinas

    California · 96156

    Office

    $113.97

    Facility

    $89.97

    $2.80 higher than Modesto for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 96156

    Office

    $114.89

    Facility

    $90.12

    $3.72 higher than Modesto for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 96156

    Office

    $125.76

    Facility

    $96.56

    $14.59 higher than Modesto for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 96156

    Office

    $125.74

    Facility

    $96.54

    $14.57 higher than Modesto for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 96156

    Office

    $127.87

    Facility

    $98.01

    $16.70 higher than Modesto for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 96156

    Office

    $127.78

    Facility

    $97.91

    $16.61 higher than Modesto for the office setting.

  • San Luis Obispo-Paso Robles

    California · 96156

    Office

    $112.32

    Facility

    $88.73

    $1.15 higher than Modesto for the office setting.

  • Santa Cruz-Watsonville

    California · 96156

    Office

    $114.67

    Facility

    $89.51

    $3.50 higher than Modesto for the office setting.

  • Santa Maria-Santa Barbara

    California · 96156

    Office

    $113.92

    Facility

    $89.77

    $2.75 higher than Modesto for the office setting.

  • Santa Rosa-Petaluma

    California · 96156

    Office

    $115.74

    Facility

    $90.31

    $4.57 higher than Modesto for the office setting.

  • Stockton

    California · 96156

    Office

    $111.17

    Facility

    $88.47

    The same base rate than Modesto for the office setting.

  • Vallejo

    California · 96156

    Office

    $120.74

    Facility

    $93.44

    $9.57 higher than Modesto for the office setting.

  • Visalia

    California · 96156

    Office

    $111.17

    Facility

    $88.47

    The same base rate than Modesto for the office setting.

  • Yuba City

    California · 96156

    Office

    $111.17

    Facility

    $88.47

    The same base rate than Modesto for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 96156

    Office

    $116.71

    Facility

    $92.32

    $5.54 higher than Modesto for the office setting.

  • Miami

    Florida · 96156

    Office

    $109.67

    Facility

    $88.11

    $1.50 lower than Modesto for the office setting.

  • Chicago

    Illinois · 96156

    Office

    $109.11

    Facility

    $88.30

    $2.06 lower than Modesto for the office setting.

  • Manhattan

    New York · 96156

    Office

    $117.40

    Facility

    $93.34

    $6.23 higher than Modesto for the office setting.

  • Alaska*

    Alaska · 96156

    Office

    $149.07

    Facility

    $127.01

    $37.90 higher than Modesto for the office setting.

  • Alabama

    Alabama · 96156

    Office

    $103.92

    Facility

    $85.80

    $7.25 lower than Modesto for the office setting.

  • Arkansas

    Arkansas · 96156

    Office

    $103.46

    Facility

    $85.67

    $7.71 lower than Modesto for the office setting.

  • Arizona

    Arizona · 96156

    Office

    $106.63

    Facility

    $86.56

    $4.54 lower than Modesto for the office setting.

  • Colorado

    Colorado · 96156

    Office

    $110.08

    Facility

    $88.04

    $1.09 lower than Modesto for the office setting.

  • Connecticut

    Connecticut · 96156

    Office

    $111.35

    Facility

    $89.05

    $0.18 higher than Modesto for the office setting.

  • Delaware

    Delaware · 96156

    Office

    $107.56

    Facility

    $87.10

    $3.61 lower than Modesto for the office setting.

  • Fort Lauderdale

    Florida · 96156

    Office

    $108.44

    Facility

    $87.46

    $2.73 lower than Modesto for the office setting.

  • Rest Of Florida

    Florida · 96156

    Office

    $106.71

    Facility

    $86.91

    $4.46 lower than Modesto for the office setting.

  • Atlanta

    Georgia · 96156

    Office

    $108.35

    Facility

    $87.31

    $2.82 lower than Modesto for the office setting.

  • Rest Of Georgia

    Georgia · 96156

    Office

    $104.79

    Facility

    $86.32

    $6.38 lower than Modesto for the office setting.

  • Hawaii, Guam

    Hawaii · 96156

    Office

    $110.93

    Facility

    $87.38

    $0.24 lower than Modesto for the office setting.

  • Iowa

    Iowa · 96156

    Office

    $104.88

    Facility

    $85.93

    $6.29 lower than Modesto for the office setting.

  • Idaho

    Idaho · 96156

    Office

    $105.06

    Facility

    $86.01

    $6.11 lower than Modesto for the office setting.

  • East St. Louis

    Illinois · 96156

    Office

    $106.09

    Facility

    $87.04

    $5.08 lower than Modesto for the office setting.

  • Rest Of Illinois

    Illinois · 96156

    Office

    $105.60

    Facility

    $86.70

    $5.57 lower than Modesto for the office setting.

  • Suburban Chicago

    Illinois · 96156

    Office

    $109.35

    Facility

    $88.08

    $1.82 lower than Modesto for the office setting.

  • Indiana

    Indiana · 96156

    Office

    $105.26

    Facility

    $86.06

    $5.91 lower than Modesto for the office setting.

  • Kansas

    Kansas · 96156

    Office

    $104.65

    Facility

    $85.93

    $6.52 lower than Modesto for the office setting.

  • Kentucky

    Kentucky · 96156

    Office

    $104.53

    Facility

    $86.12

    $6.64 lower than Modesto for the office setting.

  • New Orleans

    Louisiana · 96156

    Office

    $106.07

    Facility

    $86.58

    $5.10 lower than Modesto for the office setting.

  • Rest Of Louisiana

    Louisiana · 96156

    Office

    $104.45

    Facility

    $86.12

    $6.72 lower than Modesto for the office setting.

  • Metropolitan Boston

    Massachusetts · 96156

    Office

    $115.95

    Facility

    $91.22

    $4.78 higher than Modesto for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 96156

    Office

    $110.11

    Facility

    $88.31

    $1.06 lower than Modesto for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 96156

    Office

    $110.94

    Facility

    $88.72

    $0.23 lower than Modesto for the office setting.

  • Rest Of Maryland

    Maryland · 96156

    Office

    $108.62

    Facility

    $87.66

    $2.55 lower than Modesto for the office setting.

  • Rest Of Maine

    Maine · 96156

    Office

    $105.16

    Facility

    $86.11

    $6.01 lower than Modesto for the office setting.

  • Southern Maine

    Maine · 96156

    Office

    $107.06

    Facility

    $86.54

    $4.11 lower than Modesto for the office setting.

  • Detroit

    Michigan · 96156

    Office

    $107.07

    Facility

    $87.09

    $4.10 lower than Modesto for the office setting.

  • Rest Of Michigan

    Michigan · 96156

    Office

    $105.31

    Facility

    $86.41

    $5.86 lower than Modesto for the office setting.

  • Minnesota

    Minnesota · 96156

    Office

    $107.86

    Facility

    $86.55

    $3.31 lower than Modesto for the office setting.

  • Metropolitan Kansas City

    Missouri · 96156

    Office

    $105.91

    Facility

    $86.46

    $5.26 lower than Modesto for the office setting.

  • Metropolitan St. Louis

    Missouri · 96156

    Office

    $106.27

    Facility

    $86.56

    $4.90 lower than Modesto for the office setting.

  • Rest Of Missouri

    Missouri · 96156

    Office

    $103.85

    Facility

    $86.00

    $7.32 lower than Modesto for the office setting.

  • Mississippi

    Mississippi · 96156

    Office

    $103.66

    Facility

    $85.83

    $7.51 lower than Modesto for the office setting.

  • Montana**

    Montana · 96156

    Office

    $107.55

    Facility

    $86.84

    $3.62 lower than Modesto for the office setting.

  • North Carolina

    North Carolina · 96156

    Office

    $105.52

    Facility

    $86.20

    $5.65 lower than Modesto for the office setting.

  • North Dakota**

    North Dakota · 96156

    Office

    $107.15

    Facility

    $86.45

    $4.02 lower than Modesto for the office setting.

  • Nebraska

    Nebraska · 96156

    Office

    $105.08

    Facility

    $85.96

    $6.09 lower than Modesto for the office setting.

  • New Hampshire

    New Hampshire · 96156

    Office

    $108.56

    Facility

    $87.01

    $2.61 lower than Modesto for the office setting.

  • Northern Nj

    New Jersey · 96156

    Office

    $116.92

    Facility

    $92.90

    $5.75 higher than Modesto for the office setting.

  • Rest Of New Jersey

    New Jersey · 96156

    Office

    $113.28

    Facility

    $90.67

    $2.11 higher than Modesto for the office setting.

  • New Mexico

    New Mexico · 96156

    Office

    $105.47

    Facility

    $86.48

    $5.70 lower than Modesto for the office setting.

  • Nevada**

    Nevada · 96156

    Office

    $107.47

    Facility

    $86.74

    $3.70 lower than Modesto for the office setting.

  • Nyc Suburbs/Long Island

    New York · 96156

    Office

    $118.30

    Facility

    $93.68

    $7.13 higher than Modesto for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 96156

    Office

    $113.84

    Facility

    $91.16

    $2.67 higher than Modesto for the office setting.

  • Queens

    New York · 96156

    Office

    $117.84

    Facility

    $93.36

    $6.67 higher than Modesto for the office setting.

  • Rest Of New York

    New York · 96156

    Office

    $106.02

    Facility

    $86.34

    $5.15 lower than Modesto for the office setting.

  • Ohio

    Ohio · 96156

    Office

    $105.23

    Facility

    $86.32

    $5.94 lower than Modesto for the office setting.

  • Oklahoma

    Oklahoma · 96156

    Office

    $104.54

    Facility

    $86.05

    $6.63 lower than Modesto for the office setting.

  • Portland

    Oregon · 96156

    Office

    $111.63

    Facility

    $88.62

    $0.46 higher than Modesto for the office setting.

  • Rest Of Oregon

    Oregon · 96156

    Office

    $107.25

    Facility

    $86.62

    $3.92 lower than Modesto for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 96156

    Office

    $110.22

    Facility

    $88.66

    $0.95 lower than Modesto for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 96156

    Office

    $105.32

    Facility

    $86.31

    $5.85 lower than Modesto for the office setting.

  • Puerto Rico

    Puerto Rico · 96156

    Office

    $107.83

    Facility

    $86.90

    $3.34 lower than Modesto for the office setting.

  • Rhode Island

    Rhode Island · 96156

    Office

    $109.88

    Facility

    $88.49

    $1.29 lower than Modesto for the office setting.

  • South Carolina

    South Carolina · 96156

    Office

    $105.42

    Facility

    $86.29

    $5.75 lower than Modesto for the office setting.

  • South Dakota**

    South Dakota · 96156

    Office

    $107.11

    Facility

    $86.40

    $4.06 lower than Modesto for the office setting.

  • Tennessee

    Tennessee · 96156

    Office

    $104.81

    Facility

    $85.99

    $6.36 lower than Modesto for the office setting.

  • Austin

    Texas · 96156

    Office

    $109.18

    Facility

    $87.28

    $1.99 lower than Modesto for the office setting.

  • Beaumont

    Texas · 96156

    Office

    $105.10

    Facility

    $86.25

    $6.07 lower than Modesto for the office setting.

  • Brazoria

    Texas · 96156

    Office

    $107.80

    Facility

    $87.28

    $3.37 lower than Modesto for the office setting.

  • Dallas

    Texas · 96156

    Office

    $108.07

    Facility

    $87.44

    $3.10 lower than Modesto for the office setting.

  • Fort Worth

    Texas · 96156

    Office

    $107.81

    Facility

    $87.39

    $3.36 lower than Modesto for the office setting.

  • Galveston

    Texas · 96156

    Office

    $107.89

    Facility

    $87.33

    $3.28 lower than Modesto for the office setting.

  • Houston

    Texas · 96156

    Office

    $108.26

    Facility

    $87.69

    $2.91 lower than Modesto for the office setting.

  • Rest Of Texas

    Texas · 96156

    Office

    $106.12

    Facility

    $86.47

    $5.05 lower than Modesto for the office setting.

  • Utah

    Utah · 96156

    Office

    $105.88

    Facility

    $86.41

    $5.29 lower than Modesto for the office setting.

  • Virginia

    Virginia · 96156

    Office

    $106.90

    Facility

    $86.54

    $4.27 lower than Modesto for the office setting.

  • Virgin Islands

    United States Virgin Islands · 96156

    Office

    $107.83

    Facility

    $86.90

    $3.34 lower than Modesto for the office setting.

  • Vermont

    Vermont · 96156

    Office

    $106.95

    Facility

    $86.45

    $4.22 lower than Modesto for the office setting.

  • Rest Of Washington

    Washington · 96156

    Office

    $109.85

    Facility

    $88.04

    $1.32 lower than Modesto for the office setting.

  • Seattle (King Cnty)

    Washington · 96156

    Office

    $117.50

    Facility

    $92.09

    $6.33 higher than Modesto for the office setting.

  • Wisconsin

    Wisconsin · 96156

    Office

    $105.97

    Facility

    $86.13

    $5.20 lower than Modesto for the office setting.

  • West Virginia

    West Virginia · 96156

    Office

    $104.34

    Facility

    $86.34

    $6.83 lower than Modesto for the office setting.

  • Wyoming**

    Wyoming · 96156

    Office

    $107.38

    Facility

    $86.67

    $3.79 lower than Modesto for the office setting.

See how rates vary across the country

96156 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$103.46

$149.07

Color shows the midpoint of each state’s locality range.

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$149.071
AL$103.921
AR$103.461
AZ$106.631
CA$111.17–$127.8729
CO$110.081
CT$111.351
DC$116.711
DE$107.561
FL$106.71–$109.673
GA$104.79–$108.352
GU$110.931
HI$110.931
IA$104.881
ID$105.061
IL$105.60–$109.354
IN$105.261
KS$104.651
KY$104.531
LA$104.45–$106.072
MA$110.11–$115.952
MD$108.62–$116.713
ME$105.16–$107.062
MI$105.31–$107.072
MN$107.861
MO$103.85–$106.273
MS$103.661
MT$107.551
NC$105.521
ND$107.151
NE$105.081
NH$108.561
NJ$113.28–$116.922
NM$105.471
NV$107.471
NY$106.02–$118.305
OH$105.231
OK$104.541
OR$107.25–$111.632
PA$105.32–$110.222
PR$107.831
RI$109.881
SC$105.421
SD$107.111
TN$104.811
TX$105.10–$109.188
UT$105.881
VA$106.90–$116.712
VI$107.831
VT$106.951
WA$109.85–$117.502
WI$105.971
WV$104.341
WY$107.381

Explore 96156 on the national rate map →

Where does this rate apply?

Modesto is a Medicare payment area. Our Census mapping connects it to 33 cities and communities in California, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in California →

Why are the office and facility amounts different?

For 96156 in Modesto, the physician’s office rate is $111.17 and the facility-setting rate is $88.47: a difference of $22.70.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 96156 in Modesto. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$122.29

$111.17 × 110% = $122.29

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

Compare your contract offer →

How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 96156 in Modesto.

PPRRVU2026_Oct_nonQPP.csv

12,764

Code
96156
Physician work
2.40
Practice expense
0.80
Malpractice
0.02

GPCI2026.csv

16

Locality
Modesto
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 96156 in Modesto
ComponentRVULocality factorAdjusted
Physician work2.40× 1.0172.4408
Practice expense0.80× 1.0960.8768
Malpractice0.02× 0.5360.0107
Total RVUs3.3283
Conversion factor× 33.4009

Office / nonfacility rate, Modesto$111.17

Open 96156 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work2.41.017
Practice expense0.81.096
Malpractice0.020.536

(2.4 × 1.017 + 0.8 × 1.096 + 0.02 × 0.536) × $33.4009 = $111.17

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work2.41.017
Practice expense0.181.096
Malpractice0.020.536

(2.4 × 1.017 + 0.18 × 1.096 + 0.02 × 0.536) × $33.4009 = $88.47

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

96156 · Office / nonfacility

$111.17

Effective 2026-10-01

The base rate is $9.90 higher than on 2025-10-01, moving from $101.27 to $111.17 (9.8%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

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

  1. January 1, 2026

    RVU26A

    $101.27changed to$111.17

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.30 changed to 2.40
    • Practice expense RVU 0.70 changed to 0.80
    • Malpractice RVU 0.06 changed to 0.02
    • Work GPCI 1.014 changed to 1.017
    • Practice expense GPCI 1.093 changed to 1.096
    • Malpractice GPCI 0.560 changed to 0.536

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $101.27

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$111.17$88.47RVU26D
2026-07-01$111.17$88.47RVU26C
2026-04-01$111.17$88.47RVU26B
2026-01-01$111.17$88.47RVU26A
2025-10-01$101.27$87.84RVU25D
2025-07-01$101.27$87.84RVU25C
2025-04-01$101.27$87.84RVU25B
2025-01-01$101.27$87.84RVU25A

96156 billing questions

How is 96156 different from 96158?

96156 represents assessment or reassessment of behavioral factors affecting physical health. 96158 represents individual health behavior intervention, such as working with the patient on behavioral changes.

Can 96156 be billed in timed units?

No timed increments are specified for 96156. Document the assessment performed rather than deriving units from elapsed minutes.

What should the record support?

Document the physical health concern, the behavioral factors assessed, relevant observations or interview findings, and the clinical decisions resulting from the assessment.

When is 96127 a better fit?

Use 96127 for a brief emotional or behavioral assessment. Use 96156 when the service is a broader health-focused assessment of behavioral factors related to physical health.

Is a patient health-risk questionnaire the same service?

No. 96160 represents a patient-focused health risk assessment; 96156 involves health-focused clinical interviewing, behavioral observation, and clinical decision-making.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 96156PPRRVU2026_Oct_nonQPP.csv, line 12,764 (RVU26D)
Geographic factors for ModestoGPCI2026.csv, line 16 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet