$106.90–$116.71
96156 is for health behavior assessment or reassessment; 96158 is for the intervention addressing the identified behavioral or psychosocial concern.
On this page
CMS RVU26D · Effective 2026-10-01
96158 Health behavior Medicare reimbursement rates in Virginia
Report 96158 for an individual face-to-face intervention addressing behavioral or psychosocial factors that affect a patient’s physical health or medical treatment. Compare 96158 office and facility rates across CMS payment localities in Virginia.
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 96158 in Virginia?
Virginia 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
$73.41–$80.06
2 of 2 localities have a supported rate.
Facility setting
$59.62–$63.53
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 96158: Individual health behavior intervention
Report 96158 for an individual face-to-face intervention addressing behavioral or psychosocial factors that affect a patient’s physical health or medical treatment.
A qualified health professional works face-to-face with one patient to change behaviors or address psychosocial factors affecting a physical health condition, its treatment, or recovery. Common situations include helping a patient with chronic pain use coping strategies, supporting adherence to a diabetes treatment plan, or addressing behavior changes related to cardiovascular disease. Psychologists, clinical social workers, and other qualified professionals may provide the service in primary care or specialty medical settings.
Report 96158 for the initial 30 minutes of individual intervention with the patient. The note should identify the health condition or treatment-related concern, the behavioral intervention provided, the patient’s participation, and the time spent. Use 96159 for qualifying additional time. CMS assigns work, practice expense, and malpractice relative values; the practice-expense value differs between office and facility settings.
Where the value comes from
- Work RVU1.66 · 75%
- Practice expense (office) RVU0.54 · 24%
- Malpractice RVU0.01 · 0%
31.9K
Medicare services in 2024 · #948 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.
96158 compared with similar codes
Office rates for Virginia, from the same CMS release.
$25.28–$27.54
96158 covers the initial 30 minutes of individual intervention; 96159 is used for qualifying additional time.
$11.54–$12.76
Use 96158 for an individual patient intervention. Use 96164 when the health behavior intervention is delivered in a group.
$85.39–$93.06
90832 describes psychotherapy. 96158 addresses behavior or psychosocial factors affecting physical health or medical treatment.
Compare 96158 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
Dc + Md/Va Suburbs →
Office / nonfacility
$80.06
Facility
$63.53
Virginia →
Office / nonfacility
$73.41
Facility
$59.62
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96158 billing questions
How is 96158 different from 96156?
96156 describes a health behavior assessment or reassessment. Use 96158 when the service is an intervention intended to address behavioral or psychosocial factors affecting physical health or treatment.
When should 96159 be reported with 96158?
96158 represents the initial 30 minutes of individual intervention. Report 96159 for qualifying additional time, and document the time and intervention provided.
Can 96158 be used for a group session?
No. 96158 is for individual intervention with the patient. Group health behavior intervention is represented by 96164 for its initial time.
How does 96158 differ from psychotherapy?
96158 addresses behavioral or psychosocial factors that affect a physical health condition or its treatment. Psychotherapy codes describe treatment directed at a mental health condition.
What should the record support?
Document the physical health or treatment-related concern, the intervention and patient participation, and the time spent. The note should show that an individual face-to-face intervention was performed.
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.
12,76296139,,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
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