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CPT 96161 Medicare rate in Q4 2024

Office (non-facility) & facility

Historical · Q4 2024
$3.00

National (GPCI 1.000)

Office-only: CMS developed no facility practice-expense RVUs for 96161 (NA indicator), so the file’s facility amount repeats the Office (non-facility) one.

$2.55–$4.30 across payment localities · Office (non-facility)

Participating physician · Before sequestration

CMS evidence · Q4 2024 release

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The national PFS baseline was $3.00 for CPT 96161 in the Office (non-facility) setting and $3.00 in a facility under the Q4 2024 Physician Fee Schedule, effective October 2024. These are the national allowed amounts before locality (GPCI) adjustment; sequestration is excluded.

Contract rate as % of Medicare Copy link

Applies to your locality's allowed amount, not the $3.00 national baseline. How to find your contract's percentage.

Need rates from another insurer? Join the waitlist →

Allowed amount, Medicare's share, and patient share Copy link

A physician's $3.00 Office (non-facility) allowed amount: Medicare pays $2.35 after sequestration and the patient owes $0.60, once the Part B deductible is met.

Adjust for your locality →
96161: allowed amount and each party's share by who bills it, Office (non-facility), national baseline
Billed by Allowed amount Participating claim If not participating
What Medicare pays Patient coinsurance Non-participating amount Limiting charge
Physician (MD/DO) 100% Calculator $3.00 $2.35 $2.40 − $0.05 $0.60 $2.85 $3.28

National Q4 2024, GPCI 1.000. Rows are provider types with at least 1% of 96161’s Medicare services in CMS’s CY2024 Physician & Other Practitioners data; each % applies before the 80/20 split and sequestration.

Is $3.00 what a practice actually receives?

It's the national allowed amount—the starting point. Medicare pays 80% of it ($2.40) and the patient owes 20% coinsurance ($0.60). Sequestration trims Medicare's share by about 2%, your locality's GPCIs scale the total up or down, and the expected-payment calculator applies all three. That payment is practice revenue that covers staff, space, equipment, and billing. It isn't the clinician's take-home pay. The practice-expense RVU above is CMS's estimate of that overhead share.

Sources: Budget Control Act sequestration provisions; CMS Medicare Fee-for-Service payment guidance; CMS Geographic Practice Cost Index (GPCI) files; CMS Physician Fee Schedule overview (cms.gov).

What's the non-participating amount for 96161?

$2.85 in the Office (non-facility) setting—95% of the $3.00 participating fee schedule amount above. A participating provider takes the fee schedule amount as payment in full on every claim. A non-participating provider is paid this reduced amount, but chooses claim by claim whether to accept assignment. See participating vs non-participating.

Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.

What's the limiting charge for 96161?

$3.28 in the Office (non-facility) setting—the ceiling on what a non-participating provider can bill the patient on an unassigned claim. That's 109.25% of the $3.00 amount above. The non-participating amount is 95% of the fee schedule rate ($2.85), and the statutory cap is 115% of that. See limiting charge.

Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.

CMS RVU24DOctober 1 – December 31, 2024 See file rows

Which billing rules and modifiers apply? Copy link

CMS indicators that apply to 96161: GLOB DAYS ZZZ (add-on code) · PCTC 5 (incident-to service).

Global surgery period

Add-on code

GLOB DAYS

ZZZ

This code is always billed alongside another service and carries no follow-up period of its own. The primary procedure's global period governs; this indicator does not determine whether either line is payable.

Professional/technical split

Incident-to service

PCTC

5

An incident-to service, so there is no professional/technical split. The physician is not paid for it when the patient is a hospital inpatient or outpatient, including at a hospital clinic. The hospital bills it instead.

-26/TC Professional/technical split Not payable

CMS RVU24DOctober 1 – December 31, 2024 See file rows

Can you bill it with another code? Copy link

This code

96161

See every current NCCI pair for 96161 →

How location and RVUs set the amount Copy link

Office (non-facility) and facility: 0.09 RVUs × $33.2875 = $3.00 national PFS baseline. Local GPCIs move it from $2.55 in Mississippi, MS to $4.30 in San Jose-Sunnyvale-Santa Clara (San Benito County), CA.

Office (non-facility) and facility

Office (non-facility) and facility: each RVU times its GPCI, summed, times the conversion factor
Component RVU × GPCI =
Work 0.00 1.000 0.00
Practice expense 0.09 1.000 0.09
Malpractice 0.00 1.000 0.00
Total RVUs 0.09
× Conversion factor $33.2875
= National PFS baseline $3.00

Rates by locality Copy link

Maine: $2.74–$3.03 across 2 localities ME Wisconsin: $2.87 WI Vermont: $2.97 VT New Hampshire: $3.10 NH Montana: $3.00 MT North Dakota: $3.00 ND Minnesota: $3.07 MN Michigan: $2.73–$2.95 across 2 localities MI New York: $2.84–$3.60 across 5 localities NY Massachusetts: $3.18–$3.59 across 2 localities MA Rhode Island: $3.11 RI Washington: $3.12–$3.65 across 2 localities WA Idaho: $2.72 ID Wyoming: $3.00 WY South Dakota: $3.00 SD Iowa: $2.74 IA Illinois: $2.73–$3.14 across 4 localities IL Indiana: $2.76 IN Ohio: $2.73 OH Pennsylvania: $2.78–$3.15 across 2 localities PA New Jersey: $3.31–$3.51 across 2 localities NJ Connecticut: $3.27 CT Oregon: $2.95–$3.30 across 2 localities OR Nevada: $3.00 NV Utah: $2.80 UT Colorado: $3.15 CO Nebraska: $2.75 NE Missouri: $2.57–$2.85 across 3 localities MO Kentucky: $2.63 KY West Virginia: $2.58 WV Virginia: $2.95 VA Maryland: $3.04–$3.23 across 2 localities MD Delaware: $2.97 DE California: $3.27–$4.30 across 29 localities CA Arizona: $2.92 AZ New Mexico: $2.72 NM Kansas: $2.71 KS Oklahoma: $2.67 OK Arkansas: $2.58 AR Tennessee: $2.68 TN North Carolina: $2.77 NC South Carolina: $2.74 SC District of Columbia: $3.57 DC Texas: $2.71–$3.13 across 8 localities TX Louisiana: $2.64–$2.80 across 2 localities LA Mississippi: $2.55 MS Alabama: $2.60 AL Georgia: $2.65–$2.99 across 2 localities GA Florida: $2.82–$3.08 across 3 localities FL Alaska: $3.24 AK Hawaii: $3.44 HI
$3–$3 $3–$3 $3–$3 $3–$3 $3–$3 $3–$4

96161 Office (non-facility) by metro, highest first

San Jose, CA $4.30 Locality 01112-09 San Francisco, CA $4.25 Locality 01112-05 Seattle, WA $3.65 Locality 02402-02 Long Island, NY $3.60 Locality 13202-02 Boston, MA $3.59 Locality 14212-01 Los Angeles, CA $3.58 Locality 01182-18
Show 56 more metros
Queens, NY $3.58 Locality 13292-04 San Diego, CA $3.57 Locality 01182-72 Washington, DC $3.57 Locality 12202-01 Ventura County, CA $3.54 Locality 01182-17 Northern New Jersey, NJ $3.51 Locality 12402-01 New York City, NY $3.49 Locality 13202-01 Sacramento, CA $3.46 Locality 01112-63 Honolulu, HI $3.44 Locality 01212-01 Portland, OR $3.30 Locality 02302-01 Bakersfield, CA $3.27 Locality 01112-54 Fresno, CA $3.27 Locality 01112-56 Riverside, CA $3.27 Locality 01112-62 Hartford, CT $3.27 Locality 13102-00 Anchorage, AK $3.24 Locality 02102-01 Baltimore, MD $3.23 Locality 12302-01 Denver, CO $3.15 Locality 04112-01 Philadelphia, PA $3.15 Locality 12502-01 Suburban Chicago, IL $3.14 Locality 06102-15 Austin, TX $3.13 Locality 04412-31 Providence, RI $3.11 Locality 14412-01 Miami, FL $3.08 Locality 09102-04 Minneapolis, MN $3.07 Locality 06202-00 Chicago, IL $3.06 Locality 06102-16 Portland, ME $3.03 Locality 14112-03 Dallas, TX $3.02 Locality 04412-11 Las Vegas, NV $3.00 Locality 01312-00 Houston, TX $3.00 Locality 04412-18 Fort Lauderdale, FL $2.99 Locality 09102-03 Atlanta, GA $2.99 Locality 10212-01 Fort Worth, TX $2.99 Locality 04412-28 Detroit, MI $2.95 Locality 08202-01 Richmond, VA $2.95 Locality 11302-00 Phoenix, AZ $2.92 Locality 03102-00 Milwaukee, WI $2.87 Locality 06302-00 St. Louis, MO $2.85 Locality 05302-01 Kansas City, MO $2.84 Locality 05302-02 Buffalo, NY $2.84 Locality 13282-99 San Antonio, TX $2.83 Locality 04412-99 Tampa, FL $2.82 Locality 09102-99 New Orleans, LA $2.80 Locality 07202-01 Salt Lake City, UT $2.80 Locality 03502-09 Pittsburgh, PA $2.78 Locality 12502-99 Charlotte, NC $2.77 Locality 11502-00 Indianapolis, IN $2.76 Locality 08102-00 Metro East, IL $2.75 Locality 06102-12 Omaha, NE $2.75 Locality 05402-00 Des Moines, IA $2.74 Locality 05102-00 Charleston, SC $2.74 Locality 11202-01 Columbus, OH $2.73 Locality 15202-00 Boise, ID $2.72 Locality 02202-00 Albuquerque, NM $2.72 Locality 04212-05 Wichita, KS $2.71 Locality 05202-00 Nashville, TN $2.68 Locality 10312-35 Oklahoma City, OK $2.67 Locality 04312-00 Louisville, KY $2.63 Locality 15102-00 Birmingham, AL $2.60 Locality 10112-00
Maine: $2.74–$3.03 across 2 localities ME Wisconsin: $2.87 WI Vermont: $2.97 VT New Hampshire: $3.10 NH Montana: $3.00 MT North Dakota: $3.00 ND Minnesota: $3.07 MN Michigan: $2.73–$2.95 across 2 localities MI New York: $2.84–$3.60 across 5 localities NY Massachusetts: $3.18–$3.59 across 2 localities MA Rhode Island: $3.11 RI Washington: $3.12–$3.65 across 2 localities WA Idaho: $2.72 ID Wyoming: $3.00 WY South Dakota: $3.00 SD Iowa: $2.74 IA Illinois: $2.73–$3.14 across 4 localities IL Indiana: $2.76 IN Ohio: $2.73 OH Pennsylvania: $2.78–$3.15 across 2 localities PA New Jersey: $3.31–$3.51 across 2 localities NJ Connecticut: $3.27 CT Oregon: $2.95–$3.30 across 2 localities OR Nevada: $3.00 NV Utah: $2.80 UT Colorado: $3.15 CO Nebraska: $2.75 NE Missouri: $2.57–$2.85 across 3 localities MO Kentucky: $2.63 KY West Virginia: $2.58 WV Virginia: $2.95 VA Maryland: $3.04–$3.23 across 2 localities MD Delaware: $2.97 DE California: $3.27–$4.30 across 29 localities CA Arizona: $2.92 AZ New Mexico: $2.72 NM Kansas: $2.71 KS Oklahoma: $2.67 OK Arkansas: $2.58 AR Tennessee: $2.68 TN North Carolina: $2.77 NC South Carolina: $2.74 SC District of Columbia: $3.57 DC Texas: $2.71–$3.13 across 8 localities TX Louisiana: $2.64–$2.80 across 2 localities LA Mississippi: $2.55 MS Alabama: $2.60 AL Georgia: $2.65–$2.99 across 2 localities GA Florida: $2.82–$3.08 across 3 localities FL Alaska: $3.24 AK Hawaii: $3.44 HI
$3–$3 $3–$3 $3–$3 $3–$3 $3–$3 $3–$4

96161 Facility by metro, highest first

San Jose, CA $4.30 Locality 01112-09 San Francisco, CA $4.25 Locality 01112-05 Seattle, WA $3.65 Locality 02402-02 Long Island, NY $3.60 Locality 13202-02 Boston, MA $3.59 Locality 14212-01 Los Angeles, CA $3.58 Locality 01182-18
Show 56 more metros
Queens, NY $3.58 Locality 13292-04 San Diego, CA $3.57 Locality 01182-72 Washington, DC $3.57 Locality 12202-01 Ventura County, CA $3.54 Locality 01182-17 Northern New Jersey, NJ $3.51 Locality 12402-01 New York City, NY $3.49 Locality 13202-01 Sacramento, CA $3.46 Locality 01112-63 Honolulu, HI $3.44 Locality 01212-01 Portland, OR $3.30 Locality 02302-01 Bakersfield, CA $3.27 Locality 01112-54 Fresno, CA $3.27 Locality 01112-56 Riverside, CA $3.27 Locality 01112-62 Hartford, CT $3.27 Locality 13102-00 Anchorage, AK $3.24 Locality 02102-01 Baltimore, MD $3.23 Locality 12302-01 Denver, CO $3.15 Locality 04112-01 Philadelphia, PA $3.15 Locality 12502-01 Suburban Chicago, IL $3.14 Locality 06102-15 Austin, TX $3.13 Locality 04412-31 Providence, RI $3.11 Locality 14412-01 Miami, FL $3.08 Locality 09102-04 Minneapolis, MN $3.07 Locality 06202-00 Chicago, IL $3.06 Locality 06102-16 Portland, ME $3.03 Locality 14112-03 Dallas, TX $3.02 Locality 04412-11 Las Vegas, NV $3.00 Locality 01312-00 Houston, TX $3.00 Locality 04412-18 Fort Lauderdale, FL $2.99 Locality 09102-03 Atlanta, GA $2.99 Locality 10212-01 Fort Worth, TX $2.99 Locality 04412-28 Detroit, MI $2.95 Locality 08202-01 Richmond, VA $2.95 Locality 11302-00 Phoenix, AZ $2.92 Locality 03102-00 Milwaukee, WI $2.87 Locality 06302-00 St. Louis, MO $2.85 Locality 05302-01 Kansas City, MO $2.84 Locality 05302-02 Buffalo, NY $2.84 Locality 13282-99 San Antonio, TX $2.83 Locality 04412-99 Tampa, FL $2.82 Locality 09102-99 New Orleans, LA $2.80 Locality 07202-01 Salt Lake City, UT $2.80 Locality 03502-09 Pittsburgh, PA $2.78 Locality 12502-99 Charlotte, NC $2.77 Locality 11502-00 Indianapolis, IN $2.76 Locality 08102-00 Metro East, IL $2.75 Locality 06102-12 Omaha, NE $2.75 Locality 05402-00 Des Moines, IA $2.74 Locality 05102-00 Charleston, SC $2.74 Locality 11202-01 Columbus, OH $2.73 Locality 15202-00 Boise, ID $2.72 Locality 02202-00 Albuquerque, NM $2.72 Locality 04212-05 Wichita, KS $2.71 Locality 05202-00 Nashville, TN $2.68 Locality 10312-35 Oklahoma City, OK $2.67 Locality 04312-00 Louisville, KY $2.63 Locality 15102-00 Birmingham, AL $2.60 Locality 10112-00

Q4 2024, each locality's GPCIs, before sequestration. Multi-locality states are shaded by their mean. Look up your exact locality →

CMS RVU24DOctober 1 – December 31, 2024 See file rows

Source & method Copy link

  1. 01 PPRRVU24_OCT.csv · Q4 2024 (RVU24D) · row 18,316—status A, RVUs limits
    Source
    Physician relative value file (PPRRVU), Q4 2024 release
    Effective
    October 1 – December 31, 2024
    Locator
    PPRRVU24_OCT.csv in rvu24d.zip · row 18,316 of 18,696 · via CMS
    Fields read
    Status A (col 4) Work RVU 0 (col 6) Office (non-facility) PE RVU 0.09 (col 7) Facility PE RVU 0.09 (col 9) Malpractice RVU 0 (col 11)
    SHA-256 8ff8133723cdaa4d…
    Doesn’t establish
    A locality-adjusted allowed amount, or the payment after sequestration. National baselines use GPCI 1.000 and exclude sequestration.
    Note
    Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero.
  2. 02 Conversion factor · same file · row 18,316 · column 25—$33.2875
    Source
    Conversion factor, read from the same file as the RVUs
  3. 03 Physician & Other Practitioners · CY2024—volume and who bills it limits
    Source
    CMS Physician & Other Practitioners dataset
    Effective
    Calendar-year snapshot, on a different cycle from the Q4 2024 fee schedule
    Doesn’t establish
    Medicare Advantage, Medicaid or commercial volume.
    Note
    The dataset suppresses rows under 11 beneficiaries.

Cite this rate

CPT 96161 National PFS baseline: Office (non-facility) $3.00; Facility $3.00 (Q4 2024; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU24D, PPRRVU24_OCT.csv row 18,316. Localis. https://localishealth.com/cpt/96161/2024/D

Past releases are never edited, so the citation stays checkable after CMS publishes a newer one. Methodology · Plain-text summary · JSON

How has it changed? Copy link

$3.34 Office (non-facility) and $3.34 Facility since Jan 1, 2026, after a +14.8% increase in the Office (non-facility) amount. -28.5% decrease since Q1 2017; peak $4.67 in Q1 2017.

  1. Jan 1, 2026 – present

    Q1 2026

    Still in effect · 4 releases at this rate
    Office
    $3.34 (+$0.43, +14.8% increase)
    Facility
    $3.34 (+$0.43, +14.8% increase)

    Q1 2026 Jan 1, 2026 – Mar 31, 2026 · Q2 2026 Apr 1, 2026 – Jun 30, 2026 · Q3 2026 Jul 1, 2026 – Sep 30, 2026 · Q4 2026 Oct 1, 2026 – present

  2. Jan 1, 2025 – Dec 31, 2025

    Q1 2025

    4 releases at this rate
    Office
    $2.91 (−$0.09, -3.0% decrease)
    Facility
    $2.91 (−$0.09, -3.0% decrease)

    Q1 2025 Jan 1, 2025 – Mar 31, 2025 · Q2 2025 Apr 1, 2025 – Jun 30, 2025 · Q3 2025 Jul 1, 2025 – Sep 30, 2025 · Q4 2025 Oct 1, 2025 – Dec 31, 2025

  3. Mar 9, 2024 – Dec 31, 2024

    Q1 2024

    4 releases at this rate
    Office
    $3.00 (+$0.05, +1.7% increase)
    Facility
    $3.00 (+$0.05, +1.7% increase)

    Q1 2024 Mar 9, 2024 – Mar 31, 2024 · Q2 2024 Apr 1, 2024 – Jun 30, 2024 · Q3 2024 Jul 1, 2024 – Sep 30, 2024 · Q4 2024 Oct 1, 2024 – Dec 31, 2024

    • +$0.05 the conversion factor

  4. Jan 1, 2024 – Mar 8, 2024 · Superseded revision

    Q1 2024 rev 1

    Revision 1, later corrected by CMS
    Office
    $2.95
    Facility
    $2.95

  5. Jan 1, 2023 – Dec 31, 2023

    Q1 2023

    4 releases at this rate
    Office
    $2.71 (−$0.06, -2.2% decrease)
    Facility
    $2.71 (−$0.06, -2.2% decrease)

    Q1 2023 Jan 1, 2023 – Mar 31, 2023 · Q2 2023 Apr 1, 2023 – Jun 30, 2023 · Q3 2023 Jul 1, 2023 – Sep 30, 2023 · Q4 2023 Oct 1, 2023 – Dec 31, 2023

    • −$0.06 the conversion factor

  6. Jan 1, 2022 – Dec 31, 2022

    Q1 2022

    4 releases at this rate
    Office
    $2.77 (−$0.02, -0.7% decrease)
    Facility
    $2.77 (−$0.02, -0.7% decrease)

    Q1 2022 Jan 1, 2022 – Mar 31, 2022 · Q2 2022 Apr 1, 2022 – Jun 30, 2022 · Q3 2022 Jul 1, 2022 – Sep 30, 2022 · Q4 2022 Oct 1, 2022 – Dec 31, 2022

    • −$0.02 the conversion factor

National baseline (GPCI 1.000), before sequestration.

How each change is split
The chips under each change split the Office (non-facility) move into the conversion factor's share, which CMS sets for every code, and 96161's own work, practice-expense and malpractice RVUs. CMS doesn't publish this split; we derive it from each release's RVUs and conversion factor. We apply the new conversion factor to the earlier RVUs first, then price each RVU change at the new conversion factor. Another order would move a few cents between columns, but every total stays the same.
When does this rate change?

CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.

The 96161 rate last moved in Q1 2026. See its rate history.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

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Usage and related codes Copy link

In CY2024, 96161 ranked #3,275 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.

Services
7,318
Allowed
$18,101
Beneficiaries
3,169

CY2024 Medicare fee-for-service, from the CMS Physician & Other Practitioners dataset (limits).