How much does Medicare pay for CPT 96158?

Medicare allowed an average of $62.90 per service and paid $48.52 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $174.04, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 96158?

Treatment of behavior impacting health, initial 30 minutes. It was billed 24,412 times to 6,507 Medicare beneficiaries by 233 providers in 2024.

Does 96158 pay differently in an office than a hospital?

Yes. The allowed amount averaged $65.34 in an office setting and $57.99 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 96158 most?

Psychologist, Clinical, with 19,419 services from 191 clinicians. Next are Physical Therapist in Private Practice, Licensed Clinical Social Worker, Nurse Practitioner.

CPT 96158

Treatment of behavior impacting health, initial 30 minutes

$62.90Medicare-allowed amount per service, averaged across 24,412 services

Providers submitted

$174.04

Asking price, not received

Medicare allowed

$62.90

The fee schedule figure

Medicare paid

$48.52

Balance is patient coinsurance

Providers submitted an average of $174.04 for this code and Medicare allowed $62.90 — 2.8× 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 $48.52 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $65.34
Hospital / facility: $57.99

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. 16,317 services were billed in an office setting and 8,095 in a facility.

Services: 24,412
Beneficiaries: 6,507
Providers billing it: 233
Total allowed: $1,535,515

What Medicare pays for CPT 96158

Across 24,412 services billed by 233 providers to 6,507 beneficiaries, Medicare allowed an average of $62.90 per service. That is 3.8 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 96158

Specialty	Services	Beneficiaries	Avg allowed	Providers
Psychologist, Clinical	19,419	5,316	$63.33	191
Physical Therapist in Private Practice	3,385	468	$66.95	5
Licensed Clinical Social Worker	1,114	506	$47.49	24
Nurse Practitioner	225	60	$55.77	2
Licensed Professional Counselor	165	101	$45.91	7
Family Practice	44	15	$65.92	1
Psychiatry	24	12	$43.74	1
General Practice	19	12	$56.73	1
Clinical Cardiac Electrophysiology	17	17	$62.33	1

96158 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	6,105	$65.00	$46.77	37
Arizona	4,048	$65.63	$50.33	18
Nevada	2,155	$64.40	$51.61	3
Wisconsin	1,525	$57.65	$45.23	17
Minnesota	848	$58.07	$45.41	17
Maryland	785	$60.19	$48.93	10
Oregon	752	$61.30	$44.77	15
Florida	717	$59.38	$45.62	10
Illinois	682	$63.36	$47.66	11
New York	642	$69.87	$47.80	7
Missouri	636	$58.41	$45.72	7
Pennsylvania	630	$59.64	$46.55	7
Colorado	626	$64.61	$49.25	9
Tennessee	623	$59.63	$48.10	8
Virginia	609	$58.65	$46.00	3
Delaware	555	$69.37	$51.74	1
Maine	501	$60.74	$46.99	5
Ohio	317	$58.09	$44.16	6
Utah	264	$54.77	$40.78	6
Washington	258	$60.83	$45.24	8
Massachusetts	190	$67.41	$50.58	2
North Carolina	139	$59.76	$48.22	3
Georgia	129	$49.33	$35.72	2
Connecticut	102	$59.47	$45.37	2
Kansas	98	$60.35	$45.40	3
Michigan	96	$58.71	$45.79	4
Texas	92	$59.89	$45.59	3
Idaho	59	$56.51	$44.91	1
Kentucky	48	$50.23	$49.19	2
Indiana	42	$56.26	$45.77	1
Montana	38	$63.52	$53.05	1
New Jersey	34	$71.37	$50.74	1
Louisiana	28	$62.81	$50.46	1
Alabama	22	$56.03	$41.70	1
West Virginia	17	$62.33	$41.74	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.