Administration and interpretation of caregiver-focused health risk assessment
Medicare pricing data for 172 providers across 15 states
This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. 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
Administration and interpretation of caregiver-focused health risk assessment (HCPCS code 96161) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $2.29, but hospitals typically charge $8.86 — a 3.9x 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 $2.29, your out-of-pocket cost would be approximately $0.46. 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 3.9x more than what Medicare allows for this procedure. Medicare actually pays $1.74 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| Maryland | $3 | $18 | 9 | 365 | +41.5% |
| California | $3 | $64 | 11 | 12 | +35.4% |
| New York | $3 | $46 | 6 | 32 | +34.1% |
| Pennsylvania | $3 | $18 | 6 | 26 | +24.9% |
| New Jersey | $3 | $12 | 4 | 97 | +14.8% |
| Arizona | $3 | $6 | 2 | 375 | +14.0% |
| New Mexico | $2 | $50 | 4 | 16 | +6.6% |
| Texas | $2 | $6 | 30 | 3,948 | +4.8% |
| Georgia | $2 | $23 | 3 | 33 | +4.4% |
| Alabama | $2 | $10 | 6 | 35 | +1.7% |
| Kentucky | $2 | $21 | 3 | 90 | 0.0% |
| Louisiana | $2 | $11 | 5 | 29 | -1.3% |
| Tennessee | $2 | $214 | 31 | 39 | -2.6% |
| Iowa | $2 | $9 | 5 | 492 | -10.0% |
| Florida | $2 | $5 | 8 | 1,547 | -24.5% |
⚠️ 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