CPT 96113 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 • 10 - Telehealth in Patient's Home |
| Common Modifiers | • None • 59 - Distinct Procedural Service • AH |
| Complexity Level | Moderate |
National average reimbursement for CPT 96113 by major payers:
$74.56
$79.18
$67.81
$103.40
| 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 96113 | ||||||
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CPT 96113 vs. Other Central Nervous System Assessments/Tests (eg, Neuro-Cognitive, Mental Status, Speech Testing) Codes
The CPT 96113 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 96113 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 | 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 | 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 | 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 | 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 96113. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96113 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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Medicare Reimbursement Lookup Tool
Medicare localities are geographic regions used to adjust reimbursement rates based on local costs. Rates vary by locality to reflect differences in wages, rent, and other expenses. Sign up to see commercial rates (United/BCBS/Cigna/Aetna)
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| Year | Billing Code | Locality | Non-Facility Fee | Facility Fee |
|---|