How much does Medicare pay for CPT 96159?

Medicare allowed an average of $21.31 per service and paid $16.41 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $92.33, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 96159?

Treatment of behavior impacting health, each additional 15 minutes. It was billed 14,163 times to 2,115 Medicare beneficiaries by 102 providers in 2024.

Does 96159 pay differently in an office than a hospital?

Yes. The allowed amount averaged $21.94 in an office setting and $18.82 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 96159 most?

Psychologist, Clinical, with 12,985 services from 89 clinicians. Next are Licensed Clinical Social Worker, Licensed Professional Counselor, Family Practice.

CPT 96159

Treatment of behavior impacting health, each additional 15 minutes

$21.31Medicare-allowed amount per service, averaged across 14,163 services

Providers submitted

$92.33

Asking price, not received

Medicare allowed

$21.31

The fee schedule figure

Medicare paid

$16.41

Balance is patient coinsurance

Providers submitted an average of $92.33 for this code and Medicare allowed $21.31 — 4.3× 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 $16.41 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $21.94
Hospital / facility: $18.82

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. 11,294 services were billed in an office setting and 2,869 in a facility.

Services: 14,163
Beneficiaries: 2,115
Providers billing it: 102
Total allowed: $301,814

What Medicare pays for CPT 96159

Across 14,163 services billed by 102 providers to 2,115 beneficiaries, Medicare allowed an average of $21.31 per service. That is 6.7 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 96159

Specialty	Services	Beneficiaries	Avg allowed	Providers
Psychologist, Clinical	12,985	1,844	$21.75	89
Licensed Clinical Social Worker	988	229	$16.15	10
Licensed Professional Counselor	109	11	$14.39	1
Family Practice	65	15	$22.33	1
Clinical Cardiac Electrophysiology	16	16	$21.00	1

96159 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	4,096	$22.53	$16.21	26
Wisconsin	1,301	$19.85	$15.60	9
Tennessee	1,031	$20.56	$16.54	7
Maryland	888	$20.20	$17.48	5
Colorado	817	$21.73	$17.08	6
Illinois	674	$22.74	$16.90	5
Oregon	658	$19.81	$14.99	5
Delaware	600	$23.45	$17.51	1
Minnesota	583	$20.11	$15.82	8
Florida	571	$20.48	$15.90	4
Pennsylvania	517	$19.88	$15.86	3
Maine	490	$21.32	$16.62	2
Arizona	444	$21.78	$16.83	4
Virginia	308	$22.10	$16.33	1
Ohio	266	$19.23	$14.45	2
Massachusetts	183	$23.45	$16.71	2
North Carolina	144	$19.96	$15.82	2
Georgia	130	$14.47	$10.42	1
Connecticut	128	$19.90	$15.24	1
Washington	122	$20.42	$15.26	2
Missouri	47	$21.97	$17.72	1
Alabama	43	$18.86	$14.29	1
New Jersey	43	$24.12	$17.02	1
Montana	40	$22.26	$17.74	1
Indiana	23	$18.93	$15.35	1
West Virginia	16	$21.00	$13.88	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.