Treatment of behavior impacting health, each additional 15 minutes
Medicare pricing data for 703 providers across 31 states
Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.
💡 What You Should Know
Treatment of behavior impacting health, each additional 15 minutes (HCPCS code 96159) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $20.37, but hospitals typically charge $77.40 — a 3.8x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $20.37, your out-of-pocket cost would be approximately $4.07. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 3.8x more than what Medicare allows for this procedure. Medicare actually pays $15.76 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| New Jersey | $24 | $66 | 7 | 99 | +15.5% |
| Delaware | $23 | $61 | 1 | 492 | +14.3% |
| Maryland | $23 | $65 | 30 | 2,130 | +12.5% |
| Illinois | $22 | $60 | 36 | 1,832 | +9.4% |
| California | $22 | $108 | 93 | 5,518 | +8.9% |
| Virginia | $22 | $51 | 5 | 475 | +6.6% |
| New York | $21 | $55 | 13 | 406 | +4.6% |
| Florida | $21 | $65 | 43 | 1,299 | +3.8% |
| Missouri | $21 | $71 | 17 | 283 | +2.4% |
| Michigan | $21 | $58 | 18 | 145 | +1.4% |
| Massachusetts | $21 | $80 | 2 | 124 | +0.8% |
| Maine | $20 | $49 | 7 | 652 | +0.5% |
| Texas | $20 | $72 | 20 | 299 | -0.0% |
| Pennsylvania | $20 | $79 | 22 | 629 | -0.4% |
| Minnesota | $20 | $90 | 35 | 1,005 | -1.3% |
| Connecticut | $20 | $55 | 4 | 135 | -1.3% |
| Colorado | $20 | $171 | 39 | 941 | -1.8% |
| Wisconsin | $20 | $172 | 35 | 1,450 | -2.7% |
| Indiana | $20 | $95 | 9 | 169 | -2.9% |
| Ohio | $20 | $83 | 27 | 613 | -4.2% |
| Washington | $19 | $61 | 23 | 373 | -4.3% |
| Arizona | $19 | $63 | 21 | 673 | -5.1% |
| Idaho | $19 | $43 | 3 | 33 | -5.7% |
| Oregon | $19 | $64 | 59 | 1,136 | -6.3% |
| Alabama | $19 | $50 | 1 | 68 | -6.8% |
| North Carolina | $19 | $69 | 13 | 289 | -7.1% |
| Tennessee | $18 | $59 | 19 | 1,651 | -9.5% |
| Nevada | $18 | $24 | 3 | 3,866 | -11.5% |
| Georgia | $17 | $97 | 11 | 317 | -17.2% |
| Oklahoma | $16 | $35 | 1 | 50 | -20.2% |
| Utah | $15 | $68 | 34 | 755 | -24.6% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber