CPT 96004 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 • 22 - On Campus Outpatient Hospital • 19 - Off Campus Outpatient Hospital |
| Common Modifiers | • None • GP - Services delivered under an outpatient physical therapy plan of care • 59 - Distinct Procedural Service |
| Complexity Level | Low |
National average reimbursement for CPT 96004 by major payers:
$143.37
$146.22
$136.86
$176.34
| 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 96004 | ||||||
United | 96004 | $225.50 | 1881918415 - TUSHAR ADVANI | 910844563 | IL | Psychiatry Physician (2084P0800X) |
United | 96004 | $149.69 | 1982717120 - RODNEY EIGER | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 96004 | $225.35 | 1710206545 - NEIL JARIWALA | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 96004 | $225.35 | 1083681654 - DAVID SCHILLING | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 96004 | $186.85 | 1679968697 - JEREMIAH BREWER | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | TX | Psychiatry Physician (2084P0800X) |
United | 96004 | $261.35 | 1063471159 - MARK WAINWRIGHT | 911336707 - THE ASSOCIATION OF CHRMC AND UNIVERSITY PHYSICIANS | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 96004 | $195.41 | 1609239243 - MEGAN GINSBURG | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 96004 | $227.50 | 1083622955 - ALMA BICKNESE | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 96004 | $149.69 | 1073697132 - FEDRA NAJJAR | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96004 | $245.55 | 1144203753 - HAIDAR KABBANI | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | OH | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 96004 | $149.69 | 1619538352 - JAMES CHAMBLISS | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96004 | $60.00 | 1649599168 - RESTORATIVE HEALTH REHABILITATION INC | 272533824 - (FL) RESTORATIVE HEALTH REHABILITATION INC | FL | Home Health Agency (251E00000X) |
United | 96004 | $181.32 | 1871054817 - ERIC ZIMMERMAN | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 96004 | $138.38 | 1407848286 - ELIZABETH MIRKIN | 363305449 - (IL) MOUNT SINAI COMMUNITY FOUNDATION | IL | Psychiatry Physician (2084P0800X) |
United | 96004 | $215.82 | 1649610239 - MICHAEL BYRNE | 911780160 | 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 96004 vs. Other Neurology and Neuromuscular Procedures Codes
The CPT 96004 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 96004 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 |
|---|---|---|
| 95992-CPT | Low | Canalith Repositioning Procedure(S) (Eg, Epley Maneuver, Semont Maneuver), Per Day |
| 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 |
| 96004-CPT | Low | Review And Interpretation By Physician Or Other Qualified Health Care Professional Of Comprehensive Computer-Based Motion Analysis Dynamic Plantar Pressure Measurements Dynamic Surface Electromyography During Walking Or Other Functional Activities And Dynamic Fine Wire Electromyography With Written Report (Revised 01/01/13) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96004. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96004 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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