How much does Medicare pay for CPT 96160?

Medicare allowed an average of $2.79 per service and paid $2.01 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $28.79, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 96160?

Administration and interpretation of patient-focused health risk assessment. It was billed 201,921 times to 134,170 Medicare beneficiaries by 1,943 providers in 2024.

Does 96160 pay differently in an office than a hospital?

Yes. The allowed amount averaged $2.79 in an office setting and $2.63 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 96160 most?

Allergy/ Immunology, with 44,272 services from 486 clinicians. Next are Internal Medicine, Family Practice, Nurse Practitioner.

CPT 96160

Administration and interpretation of patient-focused health risk assessment

$2.79Medicare-allowed amount per service, averaged across 201,921 services

Providers submitted

$28.79

Asking price, not received

Medicare allowed

$2.79

The fee schedule figure

Medicare paid

$2.01

Balance is patient coinsurance

Providers submitted an average of $28.79 for this code and Medicare allowed $2.79 — 10.3× 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 $2.01 (72%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $2.79
Hospital / facility: $2.63

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. 201,848 services were billed in an office setting and 73 in a facility.

Services: 201,921
Beneficiaries: 134,170
Providers billing it: 1,943
Total allowed: $563,360

What Medicare pays for CPT 96160

Across 201,921 services billed by 1,943 providers to 134,170 beneficiaries, Medicare allowed an average of $2.79 per service. That is 1.5 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 96160

Specialty	Services	Beneficiaries	Avg allowed	Providers
Allergy/ Immunology	44,272	28,723	$2.93	486
Internal Medicine	30,931	24,972	$2.94	300
Family Practice	30,818	24,984	$2.91	361
Nurse Practitioner	29,400	20,265	$2.38	403
Pulmonary Disease	14,045	8,268	$2.72	69
Pain Management	10,612	4,007	$2.80	15
Anesthesiology	8,769	2,354	$2.76	11
Physician Assistant	8,714	6,543	$2.42	136
Physical Medicine and Rehabilitation	4,806	2,252	$2.86	15
Cardiology	3,288	1,037	$2.78	9
Neurology	2,927	1,279	$2.90	13
Endocrinology	1,854	904	$2.75	5
Obstetrics & Gynecology	1,532	1,000	$2.96	17
Interventional Pain Management	1,486	781	$2.72	4
Pediatric Medicine	1,302	688	$2.81	11

96160 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
Pennsylvania	25,433	$2.83	$2.12	131
Texas	19,734	$2.74	$2.14	212
Maryland	14,830	$3.11	$1.94	83
Delaware	13,107	$2.77	$2.19	19
Florida	12,039	$2.77	$2.17	129
New York	8,787	$3.08	$2.01	142
Oklahoma	8,550	$2.38	$1.93	85
California	8,543	$3.52	$2.12	94
North Carolina	7,857	$2.58	$2.10	54
Ohio	7,741	$2.59	$2.09	67
Tennessee	6,150	$2.33	$1.91	77
Virginia	5,907	$2.86	$2.12	44
Illinois	5,547	$2.93	$2.06	60
Indiana	5,080	$2.56	$2.01	68
Kentucky	4,258	$2.46	$2.11	66
Georgia	3,710	$2.39	$1.86	30
Massachusetts	3,376	$3.01	$1.91	52
Alabama	3,265	$2.52	$2.14	42
Arizona	3,216	$2.78	$1.87	46
Louisiana	2,992	$2.48	$2.14	28
New Jersey	2,981	$3.35	$2.19	32
Colorado	2,869	$3.00	$2.04	41
New Mexico	2,480	$2.62	$2.23	13
Kansas	2,218	$2.58	$2.00	26
Oregon	2,065	$2.69	$1.76	42
Michigan	2,031	$2.80	$2.04	35
Minnesota	1,975	$2.63	$1.99	16
South Carolina	1,642	$2.63	$2.12	25
Montana	1,630	$2.66	$1.76	12
Missouri	1,394	$2.66	$2.02	32
Washington	1,170	$3.06	$2.09	19
Arkansas	1,150	$2.39	$1.97	17
Rhode Island	1,022	$2.94	$2.04	17
Idaho	920	$2.44	$1.97	11
West Virginia	913	$2.39	$2.20	4
District of Columbia	877	$3.49	$2.34	3
Wisconsin	866	$2.75	$1.87	12
Alaska	651	$3.07	$2.13	6
Connecticut	569	$3.23	$2.07	11
Mississippi	539	$2.51	$2.20	6
Utah	523	$2.80	$2.16	3
Nebraska	355	$2.63	$1.83	6
Iowa	313	$2.68	$2.09	6
Nevada	257	$2.83	$1.92	7
Maine	210	$2.74	$2.27	5
New Hampshire	92	$2.57	$2.00	3
Guam	47	$3.49	$2.20	1
Hawaii	16	$3.37	$2.04	1
North Dakota	13	$2.59	$2.35	1
Vermont	11	$3.27	$2.34	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
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
96121Exam of neurobehavioral status$71.55

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.