CPT 96125 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 |
National average reimbursement for CPT 96125 by major payers:
$127.31
$135.61
$130.07
$161.11
| 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 96125 | ||||||
United | 96125 | $170.19 | 1679101091 - TAISHA DESTIN | 593259553 - ORLANDO HEALTH MEDICAL GROUP INC | FL | Internal Medicine Physician (207R00000X) |
United | 96125 | $97.34 | 1578567087 - JOHN COLLINS | 650984667 - (FL) MEDPEDS ASSOCIATES OF SARASOTA | FL | Internal Medicine Physician (207R00000X) |
United | 96125 | $70.86 | 1598949034 - CHARLES TALAKKOTTUR | 263696195 - (FL) TLC MEDICAL LLC | FL | Internal Medicine Physician (207R00000X) |
United | 96125 | $76.93 | 1124339700 - CESAR A VELILLA MD PA | 261131312 - (FL) CESAR A VELILLA MD PA | FL | Internal Medicine Physician (207R00000X) |
United | 96125 | $111.60 | 1568755221 - MARLOW HERNANDEZ | 992019781 - (NV) USA VEIN CLINICS OF NEVADA PLLC | FL | Internal Medicine Physician (207R00000X) |
United | 96125 | $202.20 | 1427286822 - BENJAMIN VEENSTRA | 911780160 | FL | Surgery Physician (208600000X) |
United | 96125 | $99.41 | 1447211545 - AVINASH JADHAV | 263506563 - (FL) AVINASH L JADHAV MD PA | FL | Orthopaedic Surgery Physician (207X00000X) |
United | 96125 | $92.47 | 1104929348 - CYNTHIA PRESTON | 272540542 - (FL) CYNTHIA L PRESTON MD PA | FL | Internal Medicine Physician (207R00000X) |
United | 96125 | $99.41 | 1720752470 - AVINASH L. JADHAV MD, PA, ORTHOPEDIC SPECIALIST MD | 263506563 - (FL) AVINASH L JADHAV MD PA | FL | Orthopaedic Surgery Physician (207X00000X) |
United | 96125 | $197.91 | 1104961994 - KENT SMILLIE | 10211534 - MERCY HOSPITAL | FL | Orthopaedic Surgery Physician (207X00000X) |
United | 96125 | $330.04 | 1639525058 - ALBERTO ROJAS ARANCIBIA | 131623978 | FL | Internal Medicine Physician (207R00000X) |
United | 96125 | $338.56 | 1821559311 - JAMES GUTIERREZ | 930924302 - (OR) PROVIDENCE HEALTH & SERVICES OREGON | FL | Internal Medicine Physician (207R00000X) |
United | 96125 | $97.05 | 1619298007 - WALTER SCHRATT | 421708185 | FL | Surgery Physician (208600000X) |
United | 96125 | $197.91 | 1023264868 - STEVEN ANTHONY | 10211534 - MERCY HOSPITAL | FL | Orthopaedic Surgery Physician (207X00000X) |
United | 96125 | $86.12 | 1346669447 - THE CLINICIANS, LLC, BEEPERMD | 364780075 - (FL) THE CLINICIANS LLC | FL | Internal Medicine Physician (207R00000X) |
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 96125 vs. Other Central Nervous System Assessments/Tests (eg, Neuro-Cognitive, Mental Status, Speech Testing) Codes
The CPT 96125 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 96125 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 |
|---|---|---|
| 96125-CPT | Low | Standardized Cognitive Performance Testing (Eg Ross Information Processing Assessment) Per Hour Of A Qualified Health Care Professionalstime Both Face To Face Time Administering Tests To The Patient And Time Interpreting These Test Results And Preparing The Report |
| 96127-CPT | Low | Brief Emotional/Behavioral Assessment (Eg Depression Inventory Attention-Deficit/ Hyperactivity Disorder [Adhd] Scale) With Scoringand Documentation Per Standardized Instrument |
| 96130-CPT | Low | Psychological Testing Evaluation Services By Phy- Sician Or Other Qualified Health Care Professionalincluding Integration Of Patient Data Interpre- Tation Of Standardized Test Results And Clinical Decision Making Treatment Planning And Report And Interactive Feedback To The Patient Family Member(S) Or Caregiver(S) When Performed; First Hour |
| 96131-CPT | Low | Psychological Testing Evaluation Services By Phy- Sician Or Other Qualified Health Care Professionalincluding Integration Of Patient Data Interpre- Tation Of Standardized Test Results And Clinical Decision Making Treatment Planning And Report And Interactive Feedback To The Patient Family Member(S) Or Caregiver(S) When Performed; Each Additional Hour (List Separately 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 96125. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96125 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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