Billing code 96168: Family interventionMedicare rate & RVUs in Illinois
Report this add-on for each additional 15 minutes of family health behavior intervention conducted with the patient present after the initial service.
Medicare pays $27.97–$29.01 for 96168 in the office in Illinois, from Rest Of Illinois to Chicago. Which amount applies depends on the service address.
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 9 sections
What 96168 covers
This code represents additional time in a health behavior intervention with the patient and one or more family members or caregivers present. A physician or other qualified health care professional may use the session to help the family support behavior change related to the patient’s health condition, such as following a treatment plan or making health-related lifestyle changes. Sessions may occur in an office or facility setting.
Report this code only with the initial family intervention service, 96167, when the documented service extends beyond its initial time. The record should identify the patient’s health-related concern, the family’s role in the intervention, the work performed, and the time supporting the additional unit or units. CMS classifies 96168 as an add-on code: it is billed only with a primary procedure and paid within that procedure’s global period.
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 96168 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$27.97 to $29.01
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $29.01 | $23.30 |
| East St. Louis | $28.17 | $22.94 |
| Rest Of Illinois | $27.97 | $22.78 |
| Suburban Chicago | $28.99 | $23.15 |
How the 96168 rate is calculated
Each of 96168’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 · 96168
RVUs × geographic indexes × conversion factor
Work0.63
0.63 RVUs× 1.000 GPCI
Practice expense0.21
0.21 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
0.8500
Conversion factor
$33.4009
Medicare rate
$28.39
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 96168
The CMS indicators that decide how 96168 is paid alongside other services.
CMS payment indicators · 96168
Family intervention
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
96168 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 96167Family intervention
- 96167 reports the initial family intervention with the patient present; 96168 reports additional time and is used with that primary service.
- 96171Hlth bhv ivntj fam w/o pt ea
- Both report additional family intervention time, but 96171 is for a session without the patient present; 96168 requires the patient’s presence.
- 96159Health behavior intervention
- 96159 reports additional individual intervention time with the patient, while 96168 is for family intervention with the patient present.
- 96165Group intervention
- 96165 is for additional group intervention time; 96168 is for additional family intervention time with the patient present.
96168 billing questions
When is 96168 reported with 96167?
Use 96167 for the initial family intervention and 96168 for each additional 15 minutes of qualifying intervention time. The patient must be present for this family-service code.
Can 96168 be billed by itself?
No. It is an add-on code and must be reported with its primary family intervention service, 96167.
How does 96168 differ from 96171?
96168 is for additional family intervention time with the patient present. 96171 is for additional family intervention time when the patient is not present.
What should the documentation support?
Document the health behavior concern, the patient’s presence, the family’s participation, the intervention provided, and the time supporting the additional service.
Can 96168 be used for an individual session?
No. For additional health behavior intervention time provided individually to the patient, consider 96159 rather than this family-service add-on.
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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