CPT 96131 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 • None • 10 - Telehealth in Patient's Home |
| Common Modifiers | • None • 95 - Telemedicine - audio and video • AH |
| Complexity Level | Moderate |
National average reimbursement for CPT 96131 by major payers:
$106.64
$108.86
$101.34
$127.43
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
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CPT 96131 vs. Other Central Nervous System Assessments/Tests (eg, Neuro-Cognitive, Mental Status, Speech Testing) Codes
The CPT 96131 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 96131 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 | 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 | Low | Brief Emotional/Behavioral Assessment (Eg Depression Inventory Attention-Deficit/ Hyperactivity Disorder [Adhd] Scale) With Scoringand Documentation Per Standardized Instrument |
| 96130 | 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 | 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 96131. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96131 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 |
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