CPT 96116 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 • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 95 - Telemedicine - audio and video |
| Complexity Level | Low |
National average reimbursement for CPT 96116 by major payers:
$113.09
$115.55
$109.69
$135.66
| 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 96116 | ||||||
United | 96116 | $97.84 | 1396722815 - ZAFEER BERKI | 205473097 - (IL) ZAFEER BERKI | IL | Psychiatry Physician (2084P0800X) |
United | 96116 | $181.44 | 1619123114 - MARGARET MICHELSON | 363738206 - NORTHSHORE UNIVERSITY HEALTHSYSTEM FACULTY PRACTICE ASSOCIATES | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 96116 | $125.12 | 1891180170 - SURYA SABHAPATHY | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 96116 | $147.08 | 1235436288 - AHMAD BASHIR | 363149833 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 96116 | $93.19 | 1275564197 - PAUL BERKOWITZ | 842494027 - BRIGHTSIDE MEDICAL | FL | Psychiatry Physician (2084P0800X) |
United | 96116 | $91.02 | 1255461802 - ROBERT FABSIK | 208470848 | IL | Psychiatry Physician (2084P0800X) |
United | 96116 | $97.84 | 1710206545 - NEIL JARIWALA | 223500420 - CENTER FOR FAMILY GUIDANCE, PC | IL | Psychiatry Physician (2084P0800X) |
United | 96116 | $93.19 | 1205917176 - RANDY JUNG | 371158318 - (IL) SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC | IL | Psychiatry Physician (2084P0800X) |
United | 96116 | $19.97 | 1881078392 - RADHIKA CHIMATA | 800865012 - (IL) US HEALTHVEST, LLC | IL | Psychiatry Physician (2084P0800X) |
United | 96116 | $109.80 | 1598159709 - RICHARD COCKERILL | 993971105 - WINDY CITY BEHAVIORAL HEALTH SERVICES PLLC | IL | Psychiatry Physician (2084P0800X) |
United | 96116 | $156.17 | 1063972404 - MAANASA BANDLA | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | MA | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96116 | $121.19 | 1689239865 - DANIELLE GELFOND | 843213629 | IL | Psychiatry Physician (2084P0800X) |
United | 96116 | $104.94 | 1679526784 - ELTON SMITH | 370661183 - BLESSING HOSPITAL | IL | Psychiatry Physician (2084P0800X) |
United | 96116 | $142.19 | 1679739395 - BETSY OSTRANDER | 942854057 - IHC HEALTH SERVICES INC | UT | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96116 | $97.84 | 1700992799 - EMAD AMER | 320077033 - (IL) AMER ASSOCIATES SC | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 96116 vs. Other Central Nervous System Assessments/Tests (eg, Neuro-Cognitive, Mental Status, Speech Testing) Codes
The CPT 96116 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 96116 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) |
| 96116-CPT | Low | Neurobehavioral Status Exam (Clinical Assessment Of Thinking Reasoning And Judgment [Eg Acquiredknowledge 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 (Desc Rvsd 1/1/19) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96116. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96116 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 96116) and we'll show you how you compare in 15 minutes or less.