Cómo está or Cómo está usted?

This may seem like a simple question, can someone tell me when asking asking "how someone is" in a formal situation is it required to include usted in the phrase or to simply say "Cómo está? Thanks.

Hola, It's not required to add "usted" but you definitely can - it adds emphasis on the YOU but is in the same politeness level as "Cómo está?" - Mauricio :P

Gracias Mauricio, muy apreciado.

De nada! :)