How much does Medicare pay for CPT 96156?

Medicare allowed an average of $88.46 per service and paid $68.27 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $302.12, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 96156?

Assessment of health behavior. It was billed 16,391 times to 13,290 Medicare beneficiaries by 358 providers in 2024.

Does 96156 pay differently in an office than a hospital?

Yes. The allowed amount averaged $91.54 in an office setting and $84.39 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 96156 most?

Psychologist, Clinical, with 11,248 services from 242 clinicians. Next are Licensed Clinical Social Worker, Internal Medicine, Licensed Professional Counselor.

CPT 96156

Assessment of health behavior

$88.46Medicare-allowed amount per service, averaged across 16,391 services

Providers submitted

$302.12

Asking price, not received

Medicare allowed

$88.46

The fee schedule figure

Medicare paid

$68.27

Balance is patient coinsurance

Providers submitted an average of $302.12 for this code and Medicare allowed $88.46 — 3.4× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $68.27 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $91.54
Hospital / facility: $84.39

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 9,345 services were billed in an office setting and 7,046 in a facility.

Services: 16,391
Beneficiaries: 13,290
Providers billing it: 358
Total allowed: $1,449,948

What Medicare pays for CPT 96156

Across 16,391 services billed by 358 providers to 13,290 beneficiaries, Medicare allowed an average of $88.46 per service. That is 1.2 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 96156

Specialty	Services	Beneficiaries	Avg allowed	Providers
Psychologist, Clinical	11,248	9,625	$92.46	242
Licensed Clinical Social Worker	2,752	2,215	$71.68	65
Internal Medicine	508	115	$99.85	3
Licensed Professional Counselor	476	432	$68.88	17
Psychiatry	432	179	$94.36	7
Nurse Practitioner	232	176	$79.91	6
Neuropsychiatry	143	113	$89.12	1
Neurology	136	76	$101.50	3
Family Practice	131	64	$99.90	3
Physical Therapist in Private Practice	107	94	$98.35	4
Marriage and Family Therapist	64	64	$72.22	1
Audiologist	50	49	$104.08	2
General Practice	43	43	$86.70	1
Clinical Cardiac Electrophysiology	36	14	$84.82	1
General Surgery	17	17	$100.24	1

96156 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	2,844	$99.91	$72.60	52
Florida	2,223	$80.58	$62.00	43
Minnesota	1,140	$78.73	$60.64	37
Texas	1,082	$94.16	$72.81	12
Ohio	813	$80.06	$61.90	16
Wisconsin	798	$84.77	$68.29	21
Oregon	747	$81.02	$61.30	14
Delaware	741	$98.64	$73.59	5
Pennsylvania	727	$87.91	$68.54	15
Indiana	427	$84.76	$66.15	9
New York	413	$101.35	$70.66	7
Arizona	392	$85.02	$63.56	13
Georgia	355	$89.10	$64.24	7
Colorado	339	$94.27	$70.08	11
Tennessee	313	$82.14	$64.51	9
Illinois	303	$88.19	$67.38	9
Washington	244	$96.72	$70.87	7
North Carolina	224	$91.84	$72.18	6
Utah	209	$73.61	$56.24	7
Maryland	208	$91.36	$69.02	7
Louisiana	201	$81.42	$62.51	6
West Virginia	193	$77.88	$57.66	7
Kansas	189	$85.63	$68.12	5
Alabama	182	$83.83	$69.76	3
Virginia	144	$87.86	$70.52	3
Montana	124	$95.96	$73.49	1
Connecticut	124	$86.24	$67.48	3
Kentucky	118	$83.03	$68.82	2
Michigan	112	$89.71	$66.24	3
Massachusetts	102	$101.97	$76.74	1
Missouri	71	$89.34	$67.53	4
Idaho	61	$71.03	$56.64	4
South Carolina	51	$85.88	$64.69	2
Maine	50	$84.33	$56.19	1
ZZ	37	$82.53	$68.97	1
New Jersey	23	$101.91	$74.32	1
District of Columbia	22	$98.31	$66.36	1
Mississippi	16	$92.97	$72.59	1
Oklahoma	15	$69.80	$55.36	1
New Hampshire	14	$85.76	$68.56	1

Related codes

96127Assessment of emotional or behavioral problems$4.47
96133Evaluation of neuropsychological test$92.52
96139Administration of psychological or neuropsychological test by technici$34.56
96137Administration of psychological or neuropsychological test$35.38
96132Evaluation of neuropsychological test$121.64
96160Administration and interpretation of patient-focused health risk asses$2.79
96138Administration of psychological or neuropsychological test by technici$33.17
96136Administration of psychological or neuropsychological test$38.12
96116Exam of neurobehavioral status$88.32
96130Evaluation of psychological test$112.99
96131Evaluation of psychological test$82.62
96165Treatment of behavior impacting health in group setting$4.02

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.