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See a sample rate comparisonCPT 96113 Fee Schedule
Last Verified: October 2026
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.
Devel Tst Phys Qhp Ea Addl, Developmental Test Administration Including Assessment Of Fine And Or Gross Motor Language Cognitive Level Social Memory And Or Executive Functions By Standardized Developmental Instruments When Performed By Physician Or Other Qualified Health Care Professional With Interpretation And Report Each Additional 30 Minutes List Separately In Addition To Code For Primary Procedure
| 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 | 59 - Distinct Procedural Service AH |
| Complexity Level | Low |
| Medicare Fee Schedule | $56.11 national non-facility rate (2026) · View Medicare rates for 96113 |
| Medicaid Fee Schedule | $46.035 median of the 8 states in the free preview · View Medicaid rates for 96113 |
National average reimbursement for CPT 96113 by major payers:
$74.56
$79.18
$67.81
$144.50
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CPT 96113
5 of 25 sample ratesHigher to lower in this preview
Cyril Appiagyei
Northwestern Memorial Healthcare
$153.21Published rateMatthew Niedzwiecki
$122.44Published rateMegan Ginsburg
Advocate Health And Hospitals Corporation
$106.93Published rateNasir Syed
Primary Healthcare Associates Sc
$95.48Published rateSunrise Home Health Care Inc.
Sunrise Home Health Care Inc
$25.92Published rate
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See a sample payer proposalCPT 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 |
|---|---|---|
| 96110-CPT | Low | Child Development Testing, Standardized Development Testing Including Interpretation Of Results And A Report. Tests Assess Motor Language And Social Skills As Well As Adaptive Or Cognitive Functions. |
| 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 | Devel Tst Phys Qhp Ea Addl, Developmental Test Administration Including Assessment Of Fine And Or Gross Motor Language Cognitive Level Social Memory And Or Executive Functions By Standardized Developmental Instruments When Performed By Physician Or Other Qualified Health Care Professional With Interpretation And Report Each Additional 30 Minutes List Separately In Addition To Code For Primary Procedure |
| 96116-CPT | Low | Nubhvl Xm Phys Qhp 1st Hr, Neurobehavioral Status Exam Clinical Assessment Of Thinking Reasoning And Judgment Eg Acquired Knowledge Attention Language Memory Planning And Problem Solving And Visual Spatial Abilities By Physician Or Other Qualified Health Care Professional Both Face To Face Time With The Patient And Time Interpreting Test Results And Preparing The Report First Hour |
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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