96203 Mlt fam grp bhv train ea add
What 96203 is
CMS fee schedule short descriptor: Mlt fam grp bhv train ea add.
Full CPT long descriptions are licensed by the American Medical Association and are not published on this site; the short descriptor above is the one CMS prints in its own fee schedule file. See About CPT.
Medicare payment for 96203 (CY2026)
| Work RVU | Practice expense RVU | Malpractice RVU | Total | Medicare rate | |
|---|---|---|---|---|---|
| Non-facility (office) | 0.12 | 0.03 | 0.01 | 0.16 | $5.34 |
| Facility (hospital, ASC) | 0.12 | 0.02 | 0.01 | 0.15 | $5.01 |
National rates: total RVUs x the CY2026 conversion factor of 33.4009 (non-QP), before geographic adjustment. Actual Medicare payment is 80% of the rate shown after the deductible; the patient or secondary payer owes the 20% coinsurance.
Status: Active - payable under the Physician Fee Schedule. Global period: Add-on code: global period of the primary procedure applies.
Medically Unlikely Edit (MUE)
Medicare caps 96203 at 4 units per date of service for practitioner claims (MAI 3 - date of service edit (clinical): units above the MUE may pay with documentation on appeal), rationale: Nature of Service/Procedure. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.
Billed with 96203? These codes are bundled into it
96203 is a Column 1 code in 15 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.
| Column 2 code | Short description | Modifier indicator | |
|---|---|---|---|
36591 | Draw blood off venous device | 0 - no modifier bypass | Check pair |
36592 | Collect blood from picc | 0 - no modifier bypass | Check pair |
96523 | Irrig drug delivery device | 0 - no modifier bypass | Check pair |
99401 | Prev med cnsl indiv apprx 15 | 0 - no modifier bypass | Check pair |
99402 | Prev med cnsl indiv apprx 30 | 0 - no modifier bypass | Check pair |
99403 | Prev med cnsl indiv apprx 45 | 0 - no modifier bypass | Check pair |
99404 | Prev med cnsl indiv apprx 60 | 0 - no modifier bypass | Check pair |
99406 | Behav chng smoking 3-10 min | 0 - no modifier bypass | Check pair |
99407 | Behav chng smoking > 10 min | 0 - no modifier bypass | Check pair |
99408 | Audit/dast 15-30 min | 0 - no modifier bypass | Check pair |
99409 | Audit/dast over 30 min | 0 - no modifier bypass | Check pair |
99411 | Preventive counseling group | 0 - no modifier bypass | Check pair |
99412 | Preventive counseling group | 0 - no modifier bypass | Check pair |
G0396 | Alcohol/subs interv 15-30mn | 0 - no modifier bypass | Check pair |
G0397 | Alcohol/subs interv >30 min | 0 - no modifier bypass | Check pair |
Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.