$3.60
Choose 96160 when the instrument assesses the patient’s health risks; choose 96161 when it assesses the caregiver’s health risks.
On this page
CMS RVU26D · Effective 2026-10-01
96160 Health risk assessment Medicare reimbursement rates in Connecticut
Report this service for administering and documenting a standardized instrument that assesses a patient’s health risks, alongside a qualifying primary procedure. Compare 96160 office and facility rates across CMS payment localities in Connecticut.
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.
What does Medicare pay for 96160 in Connecticut?
Connecticut has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$3.24
1 of 1 localities have a supported rate.
Payment area: Connecticut
One mapped payment locality.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Health assessment
About 96160: Patient-focused health risk assessment
Report this service for administering and documenting a standardized instrument that assesses a patient’s health risks, alongside a qualifying primary procedure.
This service covers a standardized instrument focused on the patient’s health risks, such as a health hazard appraisal, including the instrument’s scoring and documentation. The patient may complete the questions during a physician-office encounter, with practice staff administering or scoring the instrument under physician supervision when the service is billed incident-to.
Select this code when the documented service is a patient-focused risk instrument, rather than a clinician’s broader health behavior assessment or a brief emotional or behavioral screen. Keep the instrument, score, and resulting documentation in the record. CMS treats the code as an add-on: report it only with a primary procedure, and payment falls within that procedure’s global period. CMS assigns zero work and malpractice RVUs, with practice-expense RVUs in both office and facility settings.
CMS billing rules for 96160
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
- Professional and technical components
- Incident-to service: billed only when performed under physician supervision.
Where the value comes from
- Work RVU0.00 · 0%
- Practice expense (office) RVU0.09 · 100%
- Malpractice RVU0.00 · 0%
214.3K
Medicare services in 2024 · #372 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.
96160 compared with similar codes
Office rates for Connecticut, from the same CMS release.
$5.44
96127 is for a brief emotional or behavioral assessment. 96160 addresses patient-focused health risks using a standardized instrument.
$111.35
96156 describes a health behavior assessment or reassessment; 96160 covers administration, scoring, and documentation of a patient-focused risk instrument.
Compare 96160 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Connecticut →
Office / nonfacility
$3.24
Facility
Unavailable
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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 96160 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
12,767
- Code
- 96160
- Physician work
- 0.00
- Practice expense
- 0.09
- Malpractice
- 0.00
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.00 | × 1.020 | 0.0000 |
| Practice expense | 0.09 | × 1.077 | 0.0969 |
| Malpractice | 0.00 | × 1.210 | 0.0000 |
| Total RVUs | 0.0969 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Connecticut$3.24
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0 | 1.02 |
| Practice expense | 0.09 | 1.077 |
| Malpractice | 0 | 1.21 |
(0 × 1.02 + 0.09 × 1.077 + 0 × 1.21) × $33.4009 = $3.24
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.
96160 billing questions
Can 96160 be billed by itself?
No. CMS identifies it as an add-on code, so the claim must include a primary procedure; payment falls within that procedure’s global period.
What documentation supports 96160?
Document the standardized patient-focused risk instrument, its administration, the score, and the resulting assessment information.
Can practice staff administer or score the instrument?
The service may be billed incident-to only when performed under physician supervision.
How is 96160 different from 96127?
96160 concerns a patient-focused health risk instrument. 96127 is for a brief emotional or behavioral assessment.
Is 96160 interchangeable with a caregiver risk assessment?
No. 96160 is focused on the patient; 96161 is the related code for a caregiver-focused health risk assessment.
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.
12,76496156,,Hlth bhv assmt/reassessment,A,,2.40,0.80,,0.18,,0.02,3.22,2.60,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,76596158,,Hlth bhv ivntj indiv 1st 30,A,,1.66,0.54,,0.12,,0.01,2.21,1.79,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,76696159,,Hlth bhv ivntj indiv ea addl,A,,0.57,0.19,,0.04,,0.00,0.76,0.61,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,76796160,,Pt-focused hlth risk assmt,A,,0.00,0.09,,0.09,NA,0.00,0.09,0.09,5,ZZZ,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
12,76896161,,Caregiver health risk assmt,A,,0.00,0.10,,0.10,NA,0.00,0.10,0.10,5,ZZZ,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
12,76996164,,Hlth bhv ivntj grp 1st 30,A,,0.24,0.10,,0.03,,0.01,0.35,0.28,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,77096165,,Hlth bhv ivntj grp ea addl,A,,0.11,0.04,,0.01,,0.00,0.15,0.12,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808