96161
ActiveAdd-on codeCaregiver health risk assmt
96161 is an add-on code — it is only payable alongside a primary procedure: 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99242, 99243, 99244, 99245, 99252, 99253, 99254, 99255, 99281, 99282, 99283, 99284, 99285, 99288, 99291, 99292, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99366, 99374, 99375, 99377, 99378, 99379, 99380, 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394, 99395, 99396, 99397, 99401, 99402, 99403, 99404, 99406, 99407, 99408, 99409, 99411, 99412, 99415, 99416, 99460, 99461, 99462, 99463, 99466, 99467, 99468, 99469, 99471, 99472, 99475, 99476, 99477, 99478, 99479, 99480, 99487, 99489, 99490, 99491, 99492, 99493, 99494, 99495, 99496, 99497, 99498, G0463.
2026 Medicare payment
Estimated allowed amounts. Pick a locality or enter a ZIP; toggle modifiers to see how the payment rules change the number.
| Line | Qty | Non-facility (office) | Facility (hospital/ASC) |
|---|---|---|---|
| 96161 | 1 | $3.34 | $3.34 |
RVU breakdown (national)
Relative value units before geographic adjustment. Payment = (work×GPCIw + PE×GPCIpe + MP×GPCImp) × CF
| Row | Work RVU | PE RVU (office) | PE RVU (facility) | MP RVU | Total (office) |
|---|---|---|---|---|---|
| 96161 | 0.00 | 0.10 | 0.10 | 0.00 | 0.10 |
Payment policy for 96161
CMS's indicator fields, translated. These control which modifiers are payable and how.
Professional/technical (PC/TC)
pctc=5Incident-to
Covered when furnished by staff under direct physician supervision (not in hospital settings).
Multiple procedures
mult_surg=9Not applicable
The multiple-procedure concept does not apply.
Bilateral (modifier 50)
bilt_surg=9Not applicable
The bilateral concept does not apply.
Assistant surgeon (80/81/82)
asst_surg=9Not applicable
The assistant-at-surgery concept does not apply.
Co-surgeons (modifier 62)
co_surg=9Not applicable
The co-surgeon concept does not apply.
Team surgery (modifier 66)
team_surg=9Not applicable
The team-surgery concept does not apply.
Source: pfs.data.cms.gov "Indicators for 2026", retrieved 2026-07-16; conversion factors $33.4009 / $33.5675 (QP) per CMS-1832-F. Estimated amounts — not billing or coding advice.