CPT 96000 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Medicine Services and Procedures • Neurology and Neuromuscular Procedures |
| Common Place of Service | • 11 - Office • 20 - Urgent Care Facility |
| Common Modifiers | • None • GP - Services delivered under an outpatient physical therapy plan of care • KX - Requirements specified in the medical policy have been met |
| Complexity Level | Low |
National average reimbursement for CPT 96000 by major payers:
$115.26
$119.04
$110.06
$146.86
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 96000 | ||||||
United | 96000 | $180.89 | 1881918415 - TUSHAR ADVANI | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 96000 | $168.75 | 1942650130 - MALIK NASSAN | 362679194 - (IL) HEAD & NECK AND COSMETIC SURGERY ASSOCIATES, LLC | IL | Psychiatry Physician (2084P0800X) |
United | 96000 | $355.48 | 1487817128 - QURAT UL AIN KHAN | 43466314 - MASS GENERAL BRIGHAM INCORPORATED | IL | Psychiatry Physician (2084P0800X) |
United | 96000 | $225.75 | 1417900168 - SUNILA OCONNOR | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 96000 | $147.74 | 1942330576 - NASIR SYED | 364132865 - (IL) PRIMARY HEALTHCARE ASSOCIATES SC | IL | Psychiatry Physician (2084P0800X) |
United | 96000 | $112.13 | 1881012235 - LAUREN PREST | 910843135 | IL | Psychiatry Physician (2084P0800X) |
United | 96000 | $122.26 | 1316142383 - DIANE MISCH | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 96000 | $199.50 | 1225211600 - JOHN MILLICHAP | 911352172 - MULTICARE HEALTH SYSTEM | NC | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 96000 | $194.64 | 1811068554 - JAMES MACKENZIE | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96000 | $185.83 | 1962664789 - JAMIE EVANS | 910844563 | MT | Psychiatry Physician (2084P0800X) |
United | 96000 | $171.52 | 1063471159 - MARK WAINWRIGHT | 911220843 - ASSOCIATION OF UNIVERSITY PHYSICIANS | WA | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 96000 | $225.75 | 1689010373 - EWA BIEBER | 364187449 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96000 | $129.39 | 1225211600 - JOHN MILLICHAP | 454158203 - COMMUNITY CARE NETWORK INC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 96000 | $325.35 | 1275832438 - ADAM RAPPOPORT | 590634433 - THE NEMOURS FOUNDATION | FL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 96000 | $180.89 | 1639146368 - DEBORAH COUCH | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 96000 vs. Other Neurology and Neuromuscular Procedures Codes
The CPT 96000 code is part of the Medicine Services and Procedures services used for Neurology and Neuromuscular Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 96000 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 95990-CPT | Low | Refilling And Maintenance Of Implantable Pump Or Reservoir For Drug Delivery, Spinal (Intrathecal, Epidural) Or Brain (Intraventricular), Includes Electronic Analysis Of Pump, When Performed; |
| 96000-CPT | Low | Comprehensive Computer-Based Motion Analysis By Video-Taping And 3-D Kinematics |
| 96001-CPT | Low | Comprehensive Computer-Based Motion Analysis By Video-Taping And 3-D Kinematics; With Dynamic Plantar Pressure Measurements During Walking |
| 96002-CPT | Low | Dynamic Surface Electromyography, During Walking Or Other Functional Activities, 1-12 Muscles |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96000. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96000 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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