$5.28–$5.46
96164 covers the initial 30 minutes of group intervention; 96165 is the add-on for qualifying additional time.
On this page
CMS RVU26D · Effective 2026-10-01
96164 Group intervention Medicare reimbursement rates in New Jersey
Report 96164 for the initial 30 minutes of face-to-face group intervention addressing behavioral factors that affect patients’ physical health or treatment. Compare 96164 office and facility rates across CMS payment localities in New Jersey.
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 96164 in New Jersey?
New Jersey 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
$12.35–$12.75
2 of 2 localities have a supported rate.
Facility setting
$9.80–$10.04
2 of 2 localities have a 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 services
About 96164: Group health behavior intervention
Report 96164 for the initial 30 minutes of face-to-face group intervention addressing behavioral factors that affect patients’ physical health or treatment.
Code 96164 represents face-to-face health behavior intervention delivered to a group of at least two patients. A physician or other qualified health care professional works with the group on behavioral, psychological, social, or lifestyle factors affecting physical health or adherence to medical treatment. For example, patients with a chronic condition may receive group support for barriers to following a treatment plan. This is an intervention, not simply a group screening or assessment.
Report 96164 for the initial 30 minutes of the group service. The record should identify the health-related behavioral needs addressed, the intervention provided, the participants, and the time spent. Use 96165 for qualifying additional time. CMS fee-schedule valuation includes physician work, practice expense, and malpractice; the practice-expense value differs between office and facility settings. The supplied CMS rules list no special payment adjustment for this code.
Where the value comes from
- Work RVU0.24 · 69%
- Practice expense (office) RVU0.10 · 29%
- Malpractice RVU0.01 · 3%
10.2K
Medicare services in 2024 · #1457 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.
96164 compared with similar codes
Office rates for New Jersey, from the same CMS release.
$77.73–$80.22
96158 is for individual health behavior intervention. Choose 96164 when at least two patients receive the intervention as a group.
$82.28–$84.90
96167 is for family intervention with the patient participating, not a group intervention for multiple patients.
$113.28–$116.92
96156 covers health behavior assessment or reassessment. Use 96164 for face-to-face group intervention rather than assessment.
Compare 96164 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
Northern Nj →
Office / nonfacility
$12.75
Facility
$10.04
Rest Of New Jersey →
Office / nonfacility
$12.35
Facility
$9.80
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96164 billing questions
When should 96164 be used instead of 96158?
Use 96164 when the intervention is delivered to a group of at least two patients. Use 96158 for an individual health behavior intervention.
What does 96164 include?
It covers the initial 30 minutes of face-to-face group intervention focused on behavioral factors affecting physical health or medical treatment. Document the intervention and time, rather than reporting a group assessment as treatment.
How is additional group-intervention time reported?
Use 96165 for qualifying additional time beyond the initial service. Record the time spent so the initial and additional services are supported.
Can 96164 be used for a family session?
Use the family-intervention codes when the service is family-focused. Code 96167 describes the initial service when the patient participates; 96170 is for family intervention without the patient.
What documentation supports 96164?
Document the group participants, the health-related behavioral issue addressed, the intervention performed, and the face-to-face time. The note should show how the intervention relates to physical health or treatment.
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.
12,76696159,,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
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