CPT 96105 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 • Central Nervous System Assessments/Tests (eg, Neuro-Cognitive, Mental Status, Speech Testing) |
| Common Place of Service | • 11 - Office • 99 - Other POS |
| Common Modifiers | • None • GN - Services delivered under an outpatient speech language pathology plan of care • 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 96105 |
National average reimbursement for CPT 96105 by major payers:
$123.66
$123.78
$118.75
$139.50
| 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 96105 | ||||||
United | 96105 | $60.00 | 1801164967 - DA PEDIATRIC REHABILITATION | 270939565 - (FL) DA PEDIATRIC REHABILITATION | FL | Home Health Agency (251E00000X) |
United | 96105 | $200.08 | 1063972404 - MAANASA BANDLA | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96105 | $229.61 | 1780976399 - ANNA JEONG | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 96105 | $106.01 | 1225065220 - RAKESH CHANDRA | 371041283 - (IL) CHRISTOPHER GREATER AREA RURAL HEALTH PLANNING CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 96105 | $132.91 | 1871054817 - ERIC ZIMMERMAN | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 96105 | $29.55 | 1366400376 - SUNRISE HOME HEALTH CARE INC. | 650307774 - (FL) SUNRISE HOME HEALTH CARE INC | FL | Home Health Agency (251E00000X) |
United | 96105 | $132.75 | 1134127301 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 96105 | $304.85 | 1790936540 - SRISHTI NANGIA | 131623978 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 96105 | $196.63 | 1174859284 - MATTHEW NIEDZWIECKI | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 96105 | $169.21 | 1740573427 - JUSTIN JAMISON | 581672987 - (IL) EDWARD HEALTH VENTURES | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96105 | $97.63 | 1215297221 - STEPHANIE HERNANDEZ | 383989996 | IL | Psychiatry Physician (2084P0800X) |
United | 96105 | $164.66 | 1609823194 - SACRED HEART HEALTH SYSTEM INC, SACRED HEART HOME CARE | 590634434 - SACRED HEART HEALTH SYSTEM INC | FL | Home Health Agency (251E00000X) |
United | 96105 | $258.89 | 1760419311 - PETER HEYDEMANN | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 96105 | $200.16 | 1295297497 - NICOLE SHAW | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Psychiatry Physician (2084P0800X) |
United | 96105 | $179.85 | 1629177662 - BARBARA TWARDOWSKI | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
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 96105 vs. Other Central Nervous System Assessments/Tests (eg, Neuro-Cognitive, Mental Status, Speech Testing) Codes
The CPT 96105 code is part of the Medicine Services and Procedures services used for Central Nervous System Assessments/Tests (eg, Neuro-Cognitive, Mental Status, Speech Testing). 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 96105 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 |
|---|---|---|
| 96105-CPT | Low | Assessment Of Aphasia (Includes Assessment Of Expressive And Receptive Speech And Language Function, Language Comprehension, Speech Production Ability, Reading, Spelling, Writing, Eg, By Boston Diagnostic Aphasia Examination) With Interpretation And Report, Per Hou |
| 96110-CPT | Low | Developmental Screening (Eg Developmental Mile- Stone Survey Speech And Language Delay Screen) With Scoring And Documentation Per Standardized Instrument (Desc Revised 01/01/15) |
| 96112-CPT | Low | Developmental Test Administration (Including Assessment Of Fine And/Or Gross Motor Language Cognitive Level Social Memory And/Or Executive Functions By Standardized Developmental Instru- Ments When Performed) By Physician Or Other Qua- Lified Health Care Professional With Interpreta- Tion And Report; First Hour Separately In Addition To Code For Primary Procedur) |
| 96113-CPT | Low | Developmental Test Administration (Including Assessment Of Fine And/Or Gross Motor Language Cognitive Level Social Memory And/Or Executive Functions By Standardized Developmental Instru- Ments When Performed) By Physician Or Other Qua- Lified Health Care Professional With Interpreta- Tion And Report; Each Additional 30 Minutes (Listseparately In Addition To Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96105. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96105 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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