CPT 96160
Global ZZZ ActivePt-focused hlth risk assmt
This code does not have a national work RVU on the current Physician Fee Schedule. Pricing may be carrier-determined, non-covered, or tracked via a separate methodology.
CPT 96160 Billing & Documentation Guide
CPT code 96160 (Pt-focused hlth risk assmt) is classified under Medicine/E&M with a global period indicator of ZZZ. This code uses the No national RVU payment methodology rather than standard RVU-based Physician Fee Schedule pricing. Refer to the methodology notice above for billing implications.
When billing 96160, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 96160 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Add-on code (global concept does not apply)
MUE Limit (Medically Unlikely Edits)
Submitting more than 3 units of 96160 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
2026 Medicare Reimbursement by State, CPT 96160
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $3.55 | $3.55 | $3.29 - $4.33 | 29 |
| Florida | $3.02 | $3.02 | $2.87 - $3.13 | 3 |
| Georgia | $2.87 | $2.87 | $2.68 - $3.05 | 2 |
| Illinois | $2.91 | $2.91 | $2.74 - $3.09 | 4 |
| Michigan | $2.82 | $2.82 | $2.74 - $2.9 | 2 |
| North Carolina | $2.8 | $2.8 | $2.8 - $2.8 | 1 |
| New York | $3.35 | $3.35 | $2.86 - $3.57 | 5 |
| Ohio | $2.74 | $2.74 | $2.74 - $2.74 | 1 |
| Pennsylvania | $2.95 | $2.95 | $2.76 - $3.13 | 2 |
| Texas | $2.96 | $2.96 | $2.74 - $3.18 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 96160
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 96160 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0364T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0365T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0366T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0367T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0368T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0369T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0370T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0371T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0372T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0373T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 96160
What does CPT code 96160 mean? +
CPT code 96160 represents: Pt-focused hlth risk assmt. It's in the Medicine/E&M category with a global period of ZZZ.
What is the Medicare reimbursement for CPT 96160? +
The 2026 Medicare national average non-facility payment for CPT 96160 is $3.14. Rates range from $2.58 to $4.33 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 96160? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 96160? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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