$19.58–$20.58
96202 represents the initial multiple-family group training service; 96203 represents each additional 30 minutes and is reported with 96202.
On this page
CMS RVU26D · Effective 2026-10-01
96203 Family training Medicare reimbursement rates in Pennsylvania
Reports each additional 30 minutes of group behavior management training for caregivers from multiple families, following the initial service for patients with a health diagnosis. Compare 96203 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 96203 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
$5.24–$5.52
2 of 2 localities have a supported rate.
Facility setting
$4.94–$5.17
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.
Behavioral health
About 96203: Additional multiple-family behavior training
Reports each additional 30 minutes of group behavior management training for caregivers from multiple families, following the initial service for patients with a health diagnosis.
This add-on represents additional face-to-face time providing behavior management or modification training to caregivers from multiple families. The patients have a mental or physical health diagnosis and are not present during the training. A physician or other qualified health care professional may provide the service in a behavioral health, medical, or other appropriate care setting. The group format involves caregivers representing more than one patient or family, rather than a single family receiving individualized instruction.
Report 96203 only with the initial multiple-family group training service, 96202. Each unit represents an additional 30 minutes after the time represented by the primary code. Documentation should identify the caregiver group, the training provided, the patients’ relevant diagnoses, the patients’ absence, and the additional time furnished. CMS treats 96203 as an add-on code: it must be billed with a primary procedure, and its payment falls within that procedure’s global period.
CMS billing rules for 96203
- 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 RVU0.12 · 75%
- Practice expense (office) RVU0.03 · 19%
- Malpractice RVU0.01 · 6%
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.
96203 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
$76.61–$80.05
96167 describes family health behavior intervention without the patient present. Use 96203 only for additional time in the multiple-family group behavior management training service.
96170
No office rateHlth bhv ivntj fam wo pt 1st
96170 is family health behavior intervention with the patient present. 96203 is for additional time in multiple-family caregiver training with patients absent.
Compare 96203 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
$5.52
Facility
$5.17
Rest Of Pennsylvania →
Office / nonfacility
$5.24
Facility
$4.94
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96203 billing questions
Which code must accompany 96203?
Report 96203 with 96202, the code for the initial multiple-family group behavior management or modification training service.
How is the time represented?
Each unit of 96203 represents an additional 30 minutes of training beyond the initial service. Document the additional time furnished.
Must the patients attend the group?
No. This service is for caregivers from multiple families, with the patients absent.
Can 96203 be reported for one family's caregivers?
No. The service is a multiple-family group; individualized family intervention is a different service.
How does CMS treat payment for this add-on?
96203 is billed only with a primary procedure, and CMS places its payment within that 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.
12,77396170,,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
12,77496171,,Hlth bhv ivntj fam w/o pt ea,N,+,0.54,0.24,,0.12,,0.03,0.81,0.69,9,ZZZ,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
12,77596202,,Mlt fam grp bhv train 1st 60,A,,0.43,0.16,,0.08,,0.01,0.60,0.52,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,77696203,,Mlt fam grp bhv train ea add,A,,0.12,0.03,,0.02,,0.01,0.16,0.15,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,77796360,,Hydration iv infusion init,A,,0.17,0.82,,0.82,NA,0.01,1.00,1.00,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,77896361,,Hydrate iv infusion add-on,A,,0.09,0.29,,0.29,NA,0.01,0.39,0.39,5,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,77996365,,Ther/proph/diag iv inf init,A,,0.21,1.76,,1.76,NA,0.04,2.01,2.01,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00