How much does Medicare pay for CPT 96165?

Medicare allowed an average of $4.02 per service and paid $3.06 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $67.72, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 96165?

Treatment of behavior impacting health in group setting, each additional 30 minutes. It was billed 28,822 times to 1,966 Medicare beneficiaries by 62 providers in 2024.

Does 96165 pay differently in an office than a hospital?

Yes. The allowed amount averaged $4.40 in an office setting and $3.75 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 96165 most?

Psychologist, Clinical, with 23,803 services from 53 clinicians. Next are Licensed Professional Counselor, Licensed Clinical Social Worker, Internal Medicine.

CPT 96165

Treatment of behavior impacting health in group setting, each additional 30 minutes

$4.02Medicare-allowed amount per service, averaged across 28,822 services

Providers submitted

$67.72

Asking price, not received

Medicare allowed

$4.02

The fee schedule figure

Medicare paid

$3.06

Balance is patient coinsurance

Providers submitted an average of $67.72 for this code and Medicare allowed $4.02 — 16.8× 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 $3.06 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $4.40
Hospital / facility: $3.75

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. 12,062 services were billed in an office setting and 16,760 in a facility.

Services: 28,822
Beneficiaries: 1,966
Providers billing it: 62
Total allowed: $115,864

What Medicare pays for CPT 96165

Across 28,822 services billed by 62 providers to 1,966 beneficiaries, Medicare allowed an average of $4.02 per service. That is 14.7 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 96165

Specialty	Services	Beneficiaries	Avg allowed	Providers
Psychologist, Clinical	23,803	1,565	$4.18	53
Licensed Professional Counselor	2,495	126	$3.00	4
Licensed Clinical Social Worker	1,402	123	$3.02	3
Internal Medicine	950	136	$4.14	1
Occupational Therapist in Private Practice	172	16	$4.98	1

96165 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
Arizona	8,621	$4.26	$3.34	9
Florida	6,448	$3.81	$3.00	6
Minnesota	4,482	$3.61	$2.78	9
California	3,655	$4.10	$2.74	8
Wisconsin	1,944	$4.02	$3.03	8
Washington	617	$4.50	$3.23	3
Tennessee	585	$3.74	$3.16	4
New Hampshire	560	$4.60	$3.43	2
Iowa	534	$3.88	$3.10	1
Ohio	458	$4.38	$3.47	3
Oregon	285	$4.10	$2.89	3
Utah	267	$4.45	$2.77	2
Colorado	179	$4.51	$3.53	1
Connecticut	107	$4.94	$3.52	1
Pennsylvania	80	$4.04	$3.13	2

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
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.