2025 CPT code 96160
(Active) Effective Date: N/A Revision Date: N/A Medicine - Health Behavior Assessment and Intervention Procedures Medicine Services and Procedures Feed
Administration of a patient-focused health risk assessment instrument (e.g., health hazard appraisal) with scoring and documentation, per standardized instrument.
Modifiers may apply depending on the circumstances of service delivery (e.g., 24, 59, 79, 99). Consult the AMA CPT® manual for specific modifier usage guidelines.
Medical necessity is established by the patient's presentation with risk factors that impact their health, the need for personalized preventative advice, and the potential for reducing the likelihood of future health complications through lifestyle changes and preventative measures.These factors need to be documented clearly in the clinical record.
The provider administers the health risk assessment instrument, scores the results, documents the findings, and discusses the results with the patient.
In simple words: The doctor gives the patient a questionnaire to figure out their health risks.The doctor scores the answers, records them, and discusses the results with the patient.
This CPT code encompasses the administration of a standardized, patient-focused health risk assessment instrument, such as a health hazard appraisal.The procedure includes the assessment's administration, scoring of the results, and comprehensive documentation of the findings.The assessment aims to identify potential health risks impacting the patient.The instrument used must meet established criteria agreed upon by experts in the field.This code is reported once per standardized instrument administered.
Example 1: A patient presents with concerns about their family history of heart disease. The physician administers a cardiovascular risk assessment questionnaire (96160) to identify modifiable risk factors and provide personalized recommendations for prevention and management., A patient with newly diagnosed type 2 diabetes undergoes a comprehensive health risk assessment (96160) to evaluate their risk for diabetes-related complications, such as cardiovascular disease and neuropathy, and to guide lifestyle interventions., An overweight patient with hypertension wants to improve their overall health.The physician administers a health hazard appraisal questionnaire (96160) to assess their risk for various health problems, including stroke, heart disease, and obesity-related cancers. This helps guide interventions and preventative treatment plans.
* Completed health risk assessment instrument.* Documentation of the scoring and interpretation of the results.* Physician's notes reflecting discussion of results with the patient, including recommendations for follow-up care and any preventative actions to address identified risks.
** This code should only be used for standardized, validated health risk assessment instruments.
- Revenue Code: M5D (SPECIALIST - OTHER)
- RVU: This information is not provided in the source and requires additional research to determine the RVUs and reimbursement rates.
- Global Days: Not applicable
- Payment Status: Active
- Modifier TC rule: Not applicable
- Fee Schedule: Fee schedule information is not available from provided data. Consult your payer's fee schedule for current reimbursement rates.
- Specialties:Family Medicine, Internal Medicine, Cardiology, Preventive Medicine
- Place of Service:Office, Outpatient Hospital,Other Place of Service (depending on the setting where the assessment is performed)