$3.17–$3.59
Use 96161 when the caregiver completes the health risk instrument for the patient’s benefit. Use 96160 when the patient is the focus of the instrument.
On this page
CMS RVU26D · Effective 2026-10-01
96161 Health risk assessment Medicare reimbursement rates in Massachusetts
Report a scored, documented standardized health risk instrument completed by a caregiver to identify risks relevant to the patient’s care. Compare 96161 office and facility rates across CMS payment localities in Massachusetts.
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 96161 in Massachusetts?
Massachusetts has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$3.52–$3.99
2 of 2 localities have a supported rate.
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 behavior assessment
About 96161: Caregiver-focused health risk assessment
Report a scored, documented standardized health risk instrument completed by a caregiver to identify risks relevant to the patient’s care.
This service covers a standardized health risk instrument completed by a patient’s caregiver for the patient’s benefit, followed by scoring and documentation. A typical example is a caregiver completing a depression or stress screening during a child’s visit. The instrument concerns the caregiver’s health risks as they relate to the patient’s care; it is not a general clinical evaluation of the caregiver for the caregiver’s own treatment. The service may be provided in an office or another setting where the patient is receiving care.
Choose this code when the caregiver-focused instrument is administered, scored, and documented, rather than when the patient completes the instrument. Record the instrument used, who completed it, the score or result, and its relevance to the patient’s care. CMS treats this as an add-on code: report it only with a primary procedure, and payment falls within that procedure’s global period. It is an incident-to service and may be billed only when performed under physician supervision.
CMS billing rules for 96161
- 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) RVU0.10 · 100%
- Malpractice RVU0.00 · 0%
7.3K
Medicare services in 2024 · #1634 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.
96161 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
$5.19–$5.88
96127 is a brief emotional or behavioral assessment of the patient. 96161 concerns a caregiver-focused health risk instrument.
$110.11–$115.95
96156 describes a health behavior assessment or reassessment. 96161 is specifically for a standardized health risk instrument completed by the caregiver.
Compare 96161 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.
2 of 2 payment localities
Metropolitan Boston →
Office / nonfacility
$3.99
Facility
Unavailable
Rest Of Massachusetts →
Office / nonfacility
$3.52
Facility
Unavailable
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96161 billing questions
How is 96161 different from 96160?
96161 is for a health risk instrument completed by the caregiver for the patient’s benefit. 96160 is for an instrument focused on the patient.
Can 96161 be submitted by itself?
No. CMS identifies it as an add-on code, so the claim must include a primary procedure.
Does the caregiver have to complete a standardized instrument?
Yes. The service requires a caregiver-focused standardized health risk instrument, with scoring and documentation.
What documentation supports reporting 96161?
Document the instrument, the caregiver who completed it, the score or result, and how the information relates to the patient’s care.
Can practice staff perform this service?
It may be billed as an incident-to service only when performed under physician supervision.
Is 96161’s payment separate from the primary procedure’s global period?
CMS places payment for this add-on within the primary procedure’s global period.
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.
12,76596158,,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
12,77196167,,Hlth bhv ivntj fam 1st 30,A,,1.77,0.56,,0.11,,0.01,2.34,1.89,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00