$11.55
96164 covers the initial group intervention segment; 96165 is reserved for additional time and must accompany 96164.
On this page
CMS RVU26D · Effective 2026-10-01
96165 Group intervention Medicare reimbursement rates in Minnesota
Report 96165 for each additional 30-minute segment of a health behavior intervention delivered face-to-face to a group of patients. Compare 96165 office and facility rates across CMS payment localities in Minnesota.
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 96165 in Minnesota?
Minnesota 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
$5.05
1 of 1 localities have a supported rate.
Payment area: Minnesota
One mapped payment locality.
Facility setting
$4.02
1 of 1 localities have a supported rate.
Payment area: Minnesota
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 intervention
About 96165: Additional group health behavior intervention
Report 96165 for each additional 30-minute segment of a health behavior intervention delivered face-to-face to a group of patients.
A physician or other qualified health care professional uses this add-on service to address behavioral, emotional, social, or cognitive factors affecting patients’ physical health and treatment. In a group session, participants receive intervention directed toward health-related goals such as improving self-management or supporting adherence to a treatment plan. The service may be provided in an office or facility; the group format, rather than an individual or family session, distinguishes it from related intervention services.
Report 96165 only with the primary group intervention code 96164, for additional intervention time beyond the initial segment. Documentation should identify the health-related behavioral goals, the intervention provided, the group format, and the time supporting the additional segment. CMS classifies 96165 as an add-on code: it is billed only with a primary procedure and paid within that procedure’s global period. It is not a stand-alone report for a group session.
CMS billing rules for 96165
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
Where the value comes from
- Work RVU0.11 · 73%
- Practice expense (office) RVU0.04 · 27%
- Malpractice RVU0.00 · 0%
36.6K
Medicare services in 2024 · #903 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.
96165 compared with similar codes
Office rates for Minnesota, from the same CMS release.
$25.57
96159 is for additional individual intervention time with one patient; 96165 is for additional time in a group session.
$28.36
96168 covers additional time in a family intervention session, while 96165 applies to a group intervention session.
Compare 96165 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
Minnesota →
Office / nonfacility
$5.05
Facility
$4.02
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 96165 in Minnesota.
PPRRVU2026_Oct_nonQPP.csv
12,770
- Code
- 96165
- Physician work
- 0.11
- Practice expense
- 0.04
- Malpractice
- 0.00
GPCI2026.csv
66
- Locality
- Minnesota
- Physician work
- 1.000
- Practice expense
- 1.029
- Malpractice
- 0.296
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.11 | × 1.000 | 0.1100 |
| Practice expense | 0.04 | × 1.029 | 0.0412 |
| Malpractice | 0.00 | × 0.296 | 0.0000 |
| Total RVUs | 0.1512 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Minnesota$5.05
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.11 | 1 |
| Practice expense | 0.04 | 1.029 |
| Malpractice | 0 | 0.296 |
(0.11 × 1 + 0.04 × 1.029 + 0 × 0.296) × $33.4009 = $5.05
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.11 | 1 |
| Practice expense | 0.01 | 1.029 |
| Malpractice | 0 | 0.296 |
(0.11 × 1 + 0.01 × 1.029 + 0 × 0.296) × $33.4009 = $4.02
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.
96165 billing questions
Can 96165 be reported by itself?
No. It is an add-on code and must be reported with the primary group intervention code 96164.
How is 96165 different from 96164?
96164 reports the initial group intervention segment; 96165 reports each additional 30-minute segment.
When should the individual intervention codes be used instead?
Use 96158 and 96159 when the health behavior intervention is delivered to one patient rather than a group.
What should the note support?
Document the health-related behavioral goals, the intervention delivered, that it was a group session, and the time supporting the additional segment.
Can 96165 be used for a family intervention?
No. Family intervention services are reported with the family-session code family, such as 96167 and 96168, rather than the group codes.
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.
12,76796160,,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
12,77296168,,Hlth bhv ivntj fam ea addl,A,,0.63,0.21,,0.04,,0.01,0.85,0.68,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,77396170,,Hlth bhv ivntj fam wo pt 1st,N,+,1.50,0.66,,0.33,,0.08,2.24,1.91,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
6314212,MA,99,REST OF MASSACHUSETTS,1.016,1.053,0.797
6408202,MI,01,DETROIT,1.000,0.965,1.686
6508202,MI,99,REST OF MICHIGAN,1.000,0.913,1.129
6606202,MN,00,MINNESOTA,1.000,1.029,0.296
6707302,MS,00,MISSISSIPPI,1.000,0.861,0.739
6805302,MO,02,METROPOLITAN KANSAS CITY,1.000,0.939,0.977
6905302,MO,01,METROPOLITAN ST. LOUIS,1.000,0.952,1.002