$72.32–$75.62
96156 assesses behavioral factors affecting physical health; 96158 reports individual intervention addressing health behavior.
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CMS RVU26D · Effective 2026-10-01
96156 Health behavior assessment Medicare reimbursement rates in Pennsylvania
Report 96156 for a health-focused assessment of behavioral factors affecting a patient's physical condition, treatment adherence, or health outcomes. Compare 96156 office and facility rates across CMS payment localities in Pennsylvania.
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 96156 in Pennsylvania?
Pennsylvania 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
$105.32–$110.22
2 of 2 localities have a supported rate.
Facility setting
$86.31–$88.66
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 96156: Health behavior assessment or reassessment
Report 96156 for a health-focused assessment of behavioral factors affecting a patient's physical condition, treatment adherence, or health outcomes.
96156 covers a health-focused clinical interview, behavioral observations, and clinical decision-making to assess how a patient's behavior and other personal factors relate to physical health. Physicians and other qualified health professionals may perform it in settings such as primary care or specialty clinics for patients managing conditions such as diabetes, chronic pain, or obesity. The focus is the connection between behavior and physical health, rather than psychotherapy or psychological testing.
Choose the code when the encounter consists of assessment or reassessment, not active behavioral intervention. Document the health condition or concern, relevant behavioral factors, assessment findings, and resulting clinical decisions. The service is not selected in timed increments; elapsed minutes alone do not establish additional units. CMS assigns physician work and practice-expense relative values, with practice-expense inputs differing between office and facility settings.
Where the value comes from
- Work RVU2.40 · 75%
- Practice expense (office) RVU0.80 · 25%
- Malpractice RVU0.02 · 1%
20.4K
Medicare services in 2024 · #1139 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.
96156 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
$4.61–$5.27
96127 is for a brief emotional or behavioral assessment. 96156 describes a health-focused assessment or reassessment tied to physical health.
$2.76–$3.13
96160 is a patient-focused health risk assessment; 96156 involves clinical assessment of behavior in relation to a health condition or concern.
$120.85–$127.49
96130 reports psychological test evaluation, including interpretation and clinical integration. 96156 is a health behavior assessment, not psychological test evaluation.
Compare 96156 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 Philadelphia →
Office / nonfacility
$110.22
Facility
$88.66
Rest Of Pennsylvania →
Office / nonfacility
$105.32
Facility
$86.31
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96156 billing questions
How is 96156 different from 96158?
96156 represents assessment or reassessment of behavioral factors affecting physical health. 96158 represents individual health behavior intervention, such as working with the patient on behavioral changes.
Can 96156 be billed in timed units?
No timed increments are specified for 96156. Document the assessment performed rather than deriving units from elapsed minutes.
What should the record support?
Document the physical health concern, the behavioral factors assessed, relevant observations or interview findings, and the clinical decisions resulting from the assessment.
When is 96127 a better fit?
Use 96127 for a brief emotional or behavioral assessment. Use 96156 when the service is a broader health-focused assessment of behavioral factors related to physical health.
Is a patient health-risk questionnaire the same service?
No. 96160 represents a patient-focused health risk assessment; 96156 involves health-focused clinical interviewing, behavioral observation, and clinical decision-making.
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.
12,76196138,,Psycl/nrpsyc tech 1st,A,,0.00,1.12,,1.12,NA,0.01,1.13,1.13,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,04,0,99,0.00,0.00,0.00
12,76296139,,Psycl/nrpsyc tst tech ea,A,,0.00,1.06,,1.06,NA,0.00,1.06,1.06,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,04,0,99,0.00,0.00,0.00
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