$105.06
96156 is for health behavior assessment or reassessment; 96158 is for the intervention addressing the identified behavioral or psychosocial concern.
On this page
CMS RVU26D · Effective 2026-10-01
96158 Health behavior Medicare reimbursement rates in Idaho
Report 96158 for an individual face-to-face intervention addressing behavioral or psychosocial factors that affect a patient’s physical health or medical treatment. Compare 96158 office and facility rates across CMS payment localities in Idaho.
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 96158 in Idaho?
Idaho 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
$72.20
1 of 1 localities have a supported rate.
Payment area: Idaho
One mapped payment locality.
Facility setting
$59.29
1 of 1 localities have a supported rate.
Payment area: Idaho
One mapped payment locality.
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 behavior services
About 96158: Individual health behavior intervention
Report 96158 for an individual face-to-face intervention addressing behavioral or psychosocial factors that affect a patient’s physical health or medical treatment.
A qualified health professional works face-to-face with one patient to change behaviors or address psychosocial factors affecting a physical health condition, its treatment, or recovery. Common situations include helping a patient with chronic pain use coping strategies, supporting adherence to a diabetes treatment plan, or addressing behavior changes related to cardiovascular disease. Psychologists, clinical social workers, and other qualified professionals may provide the service in primary care or specialty medical settings.
Report 96158 for the initial 30 minutes of individual intervention with the patient. The note should identify the health condition or treatment-related concern, the behavioral intervention provided, the patient’s participation, and the time spent. Use 96159 for qualifying additional time. CMS assigns work, practice expense, and malpractice relative values; the practice-expense value differs between office and facility settings.
Where the value comes from
- Work RVU1.66 · 75%
- Practice expense (office) RVU0.54 · 24%
- Malpractice RVU0.01 · 0%
31.9K
Medicare services in 2024 · #948 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.
96158 compared with similar codes
Office rates for Idaho, from the same CMS release.
$24.88
96158 covers the initial 30 minutes of individual intervention; 96159 is used for qualifying additional time.
$11.25
Use 96158 for an individual patient intervention. Use 96164 when the health behavior intervention is delivered in a group.
$84.01
90832 describes psychotherapy. 96158 addresses behavior or psychosocial factors affecting physical health or medical treatment.
Compare 96158 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
Idaho →
Office / nonfacility
$72.20
Facility
$59.29
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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 96158 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
12,765
- Code
- 96158
- Physician work
- 1.66
- Practice expense
- 0.54
- Malpractice
- 0.01
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.66 | × 1.000 | 1.6600 |
| Practice expense | 0.54 | × 0.920 | 0.4968 |
| Malpractice | 0.01 | × 0.473 | 0.0047 |
| Total RVUs | 2.1615 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Idaho$72.20
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.66 | 1 |
| Practice expense | 0.54 | 0.92 |
| Malpractice | 0.01 | 0.473 |
(1.66 × 1 + 0.54 × 0.92 + 0.01 × 0.473) × $33.4009 = $72.20
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.66 | 1 |
| Practice expense | 0.12 | 0.92 |
| Malpractice | 0.01 | 0.473 |
(1.66 × 1 + 0.12 × 0.92 + 0.01 × 0.473) × $33.4009 = $59.29
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.
96158 billing questions
How is 96158 different from 96156?
96156 describes a health behavior assessment or reassessment. Use 96158 when the service is an intervention intended to address behavioral or psychosocial factors affecting physical health or treatment.
When should 96159 be reported with 96158?
96158 represents the initial 30 minutes of individual intervention. Report 96159 for qualifying additional time, and document the time and intervention provided.
Can 96158 be used for a group session?
No. 96158 is for individual intervention with the patient. Group health behavior intervention is represented by 96164 for its initial time.
How does 96158 differ from psychotherapy?
96158 addresses behavioral or psychosocial factors that affect a physical health condition or its treatment. Psychotherapy codes describe treatment directed at a mental health condition.
What should the record support?
Document the physical health or treatment-related concern, the intervention and patient participation, and the time spent. The note should show that an individual face-to-face intervention was performed.
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.
12,76296139,,Psycl/nrpsyc tst tech ea,A,,0.00,1.06,,1.06,NA,0.00,1.06,1.06,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,04,0,99,0.00,0.00,0.00
12,76396146,,Psycl/nrpsyc tst auto result,A,,0.00,0.06,,0.06,NA,0.01,0.07,0.07,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,04,0,99,0.00,0.00,0.00
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
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772