96160
Pt-focused hlth risk assmt
Administration of a patient-focused health risk assessment instrument, with scoring and documentation, per standardized tool. CMS 2026 wRVU 0.05. The patient-completed HRA used at preventive visits, AWVs, and chronic disease management encounters.
When to use it
Use 96160 when a standardized, validated patient-focused health risk assessment instrument is administered to the patient and scored. Common tools: HRA-Plus, ACG, Risk Pathfinder, Welltok HRA, validated wellness HRAs.
Full guidance
Most commonly used at the AWV (G0438 or G0439) where an HRA is structurally required. The respondent is the patient themselves. Each separately administered standardized tool counts as one unit. Companion code 96161 is the caregiver-focused version (caregiver fills out the HRA on behalf of a dependent patient).
Documentation checklist
- ✓Name of the validated HRA tool used.
- ✓Numeric score or domain-level interpretation.
- ✓Action plan based on findings (referrals, lifestyle counseling, follow-up testing).
- ✓Document the respondent as the patient (not the caregiver — that's 96161).
- ✓Tool should be evidence-based and validated; internally-built questionnaires don't qualify.
Common pitfalls
- !Confused with 96161 (caregiver-focused). Pick by respondent: patient = 96160, caregiver = 96161.
- !Billing 96160 when no formal HRA was administered. Free-text social history doesn't count.
- !Forgetting to bill 96160 at AWV visits where an HRA is administered (it's structurally required, and 96160 is separately billable).
- !Using a non-validated tool. Stick to recognized HRAs.
- !Missing the action plan. The action plan based on results is part of the structural deliverable.
Payer notes
Medicare covers 96160 when administered at appropriate preventive visits. Medicare Advantage plans typically follow Medicare. Commercial payers vary; many cover 96160 as part of routine adult preventive care. Documentation of the standardized tool name and score is critical for audit defense.