CPT 96110 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 • 50 - Federally Qualified Health Center |
| Common Modifiers | • None • 59 - Distinct Procedural Service • EP - Residential facility to Physician's office |
| Complexity Level | Low |
National average reimbursement for CPT 96110 by major payers:
$14.31
$14.86
$13.91
$18.04
| 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 96110 | ||||||
United | 96110 | $24.04 | 1770825143 - NATINA AUYEUNG | 131623978 | NY | Pediatrics Physician (208000000X) |
United | 96110 | $31.32 | 1386170256 - CHANDRIKA SRIDHARAMURTHY | 131623978 | NY | Pediatrics Physician (208000000X) |
United | 96110 | $27.00 | 1962087577 - PATRICIA SOMMER | 453023019 - (NY) NORTH SHORE-LIJ MEDICAL PC | NY | Pediatrics Physician (208000000X) |
United | 96110 | $11.31 | 1285661868 - VINCENT PALUSCI | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | NY | Pediatrics Physician (208000000X) |
United | 96110 | $8.22 | 1730175167 - ANOOP SINGH | 275555205 | NY | Pediatrics Physician (208000000X) |
United | 96110 | $20.46 | 1093370728 - REBECCA SIMON | 135562308 - NEW YORK UNIVERSITY | NY | Pediatrics Physician (208000000X) |
United | 96110 | $21.50 | 1689752370 - MARVIN RESMOVITS | 133544120 - CAREMOUNT MEDICAL, P.C. | NY | Pediatrics Physician (208000000X) |
United | 96110 | $24.50 | 1023172418 - BARBARA CUSUMANO | 112571524 - (NY) STONY BROOK CHILDRENS SERVICE UNIVERSITY FACULTY PRACTICE CORP | NY | Pediatrics Physician (208000000X) |
United | 96110 | $97.00 | 1215163100 - CHRISTINE STERN | 132693549 - (NY) PEDIATRIC ASSOCIATES OF N.Y.C., P.C. | NY | Pediatrics Physician (208000000X) |
United | 96110 | $12.44 | 1396883997 - FRANCIA DEVERA | 133460911 - (NY) AMB MEDICAL SERVICES P.C. D/B/A DOC CARE | NY | Pediatrics Physician (208000000X) |
United | 96110 | $38.52 | 1811301799 - MARIANN JACOB | 112571524 - (NY) STONY BROOK CHILDRENS SERVICE UNIVERSITY FACULTY PRACTICE CORP | NY | Pediatrics Physician (208000000X) |
United | 96110 | $12.27 | 1548528912 - JOLIE HSU | 202840362 - (NY) PEDIATRICS 2000AT 207 STREET PLLC | NY | Pediatrics Physician (208000000X) |
United | 96110 | $11.77 | 1063586592 - FIRDOUS RIZVI | 131974191 - (NY) BRONXCARE HEALTH SYSTEM | NY | Pediatrics Physician (208000000X) |
United | 96110 | $13.40 | 1457322125 - VALERIY CHORNY | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | NY | Pediatrics Physician (208000000X) |
United | 96110 | $84.75 | 1962471557 - BRUCE BROVENDER | 135562308 - NEW YORK UNIVERSITY | NY | Pediatrics Physician (208000000X) |
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 96110 vs. Other Central Nervous System Assessments/Tests (eg, Neuro-Cognitive, Mental Status, Speech Testing) Codes
The CPT 96110 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 96110 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 96110. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96110 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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