$72.25
96158 covers the initial individual intervention time; 96159 is the add-on for additional time and is reported with 96158.
On this page
CMS RVU26D · Effective 2026-10-01
96159 Health behavior intervention Medicare reimbursement rates in Ohio
Report 96159 for additional time spent in an individual health behavior intervention addressing behavioral factors that affect a patient’s physical health. Compare 96159 office and facility rates across CMS payment localities in Ohio.
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 96159 in Ohio?
Ohio 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
$24.83
1 of 1 localities have a supported rate.
Payment area: Ohio
One mapped payment locality.
Facility setting
$20.26
1 of 1 localities have a supported rate.
Payment area: Ohio
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 96159: Individual health behavior intervention, additional time
Report 96159 for additional time spent in an individual health behavior intervention addressing behavioral factors that affect a patient’s physical health.
This add-on represents additional face-to-face time in an individual intervention focused on behavior affecting physical health. A physician or other qualified health care professional may use the service to help a patient address challenges such as following a chronic disease treatment plan, improving self-management, or coping with pain. The work is directed toward changing health-related behavior, rather than administering or interpreting psychological tests.
Report 96159 with the primary individual intervention code, 96158, when the documented service extends beyond its initial time. The record should identify the health-related behavioral target, intervention provided, patient participation, and time supporting the additional units. It is not a stand-alone service. CMS classifies 96159 as an add-on and pays it within the primary procedure’s global period.
CMS billing rules for 96159
- 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 RVU0.57 · 75%
- Practice expense (office) RVU0.19 · 25%
- Malpractice RVU0.00 · 0%
22.5K
Medicare services in 2024 · #1096 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.
96159 compared with similar codes
Office rates for Ohio, from the same CMS release.
$105.23
96156 describes health behavior assessment or reassessment. Choose 96159 only for additional time spent delivering an individual intervention.
$11.40
96164 is for an initial group intervention. 96159 is for additional time in an individual intervention, not group work.
$76.53
96167 is the initial family intervention code for a session with the patient present; 96159 is additional individual intervention time.
Compare 96159 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
Ohio →
Office / nonfacility
$24.83
Facility
$20.26
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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 96159 in Ohio.
PPRRVU2026_Oct_nonQPP.csv
12,766
- Code
- 96159
- Physician work
- 0.57
- Practice expense
- 0.19
- Malpractice
- 0.00
GPCI2026.csv
85
- Locality
- Ohio
- Physician work
- 1.000
- Practice expense
- 0.913
- Malpractice
- 1.008
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.57 | × 1.000 | 0.5700 |
| Practice expense | 0.19 | × 0.913 | 0.1735 |
| Malpractice | 0.00 | × 1.008 | 0.0000 |
| Total RVUs | 0.7435 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Ohio$24.83
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.57 | 1 |
| Practice expense | 0.19 | 0.913 |
| Malpractice | 0 | 1.008 |
(0.57 × 1 + 0.19 × 0.913 + 0 × 1.008) × $33.4009 = $24.83
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.57 | 1 |
| Practice expense | 0.04 | 0.913 |
| Malpractice | 0 | 1.008 |
(0.57 × 1 + 0.04 × 0.913 + 0 × 1.008) × $33.4009 = $20.26
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.
96159 billing questions
When should 96159 be reported instead of 96158?
96158 represents the initial individual intervention time. Report 96159 for additional intervention time after that initial service, with 96158 as the primary code.
Can 96159 be billed by itself?
No. It is an add-on code and must be reported with its primary individual intervention code, 96158.
What should the note support?
Document the health-related behavior addressed, the intervention performed, patient participation, and the additional time. The note should distinguish intervention from assessment or testing.
Is this code for group counseling or family intervention?
No. 96159 is for additional time in an individual intervention. Group and family formats have separate health behavior intervention codes.
How does 96159 differ from 96156?
96156 represents a health behavior assessment or reassessment. 96159 represents additional time providing an individual intervention, paired with 96158.
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.
12,76396146,,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
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
8213282,NY,99,REST OF NEW YORK,1.000,0.950,0.703
8311502,NC,00,NORTH CAROLINA,1.000,0.933,0.639
8403302,ND,01,NORTH DAKOTA**,1.000,1.000,0.406
8515202,OH,00,OHIO,1.000,0.913,1.008
8604312,OK,00,OKLAHOMA,1.000,0.893,0.777
8702302,OR,01,PORTLAND,1.016,1.111,0.744
8802302,OR,99,REST OF OREGON,1.000,0.996,0.703