CPT 96133 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 AH 95 - Telemedicine - audio and video |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 96133 |
| Medicaid Fee Schedule | View Medicaid rates for 96133 |
National average reimbursement for CPT 96133 by major payers:
$122.06
$121.91
$115.28
$122.57
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 96133 | $208.25 | 1710244991 - ALBA PERGJIKA | 364187449 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96133 | $112.06 | 1154749844 - NORA EKEANYA | 370661183 - BLESSING HOSPITAL | CA | Psychiatry Physician (2084P0800X) |
United | 96133 | $291.70 | 1790936540 - SRISHTI NANGIA | 131623978 | NY | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 96133 | $173.83 | 1568956043 - REID ALLEY | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | PA | Psychiatry Physician (2084P0800X) |
United | 96133 | $162.86 | 1255598512 - ASTRID HERARD | 910844563 | IL | Psychiatry Physician (2084P0800X) |
United | 96133 | $81.81 | 1184661407 - MICHAEL BEDNARZ | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | IL | Psychiatry Physician (2084P0800X) |
United | 96133 | $189.69 | 1063972404 - MAANASA BANDLA | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | MA | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96133 | $77.23 | 1871907774 - ODAY ALSARRAF | 561509260 - REX HOSPITAL INC | IL | Psychiatry Physician (2084P0800X) |
United | 96133 | $166.14 | 1306259817 - KHALID ARSHAD | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96133 | $173.50 | 1528164829 - GUOSHI ZHANG | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 96133 | $98.94 | 1104082734 - JADA JOHNSON | 370964629 - (IL) CHESTNUT HEALTH SYSTEMS INC | IL | Psychiatry Physician (2084P0800X) |
United | 96133 | $128.22 | 1417485947 - BRANDON HAGE | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96133 | $98.94 | 1720288095 - REGINA LOPEZ | 370916475 - (IL) CENTERSTONE OF ILLINOIS INC | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96133 | $103.90 | 1942392212 - ATUL SHETH | 223500420 - CENTER FOR FAMILY GUIDANCE, PC | WI | Psychiatry Physician (2084P0800X) |
United | 96133 | $117.62 | 1508139262 - ALESSANDRA TACHAUER | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | 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 |
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CPT 96133 vs. Other Central Nervous System Assessments/Tests (eg, Neuro-Cognitive, Mental Status, Speech Testing) Codes
The CPT 96133 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 96133 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 | Cognitive Test By Hc Pro, Standardized Cognitive Performance Testing Eg Ross Information Processing Assessment Per Hour Of A Qualified Health Care Professional S Time 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 Behav Assmt, Brief Emotional Behavioral Assessment Eg Depression Inventory Attention Deficit Hyperactivity Disorder Adhd Scale With Scoring And Documentation Per Standardized Instrument |
| 96130-CPT | Low | Psycl Tst Eval Phys Qhp 1st, Psychological Testing Evaluation Services By Physician Or Other Qualified Health Care Professional Including Integration Of Patient Data Interpretation Of Standardized Test Results And Clinical Data Clinical Decision Making Treatment Planning And Report And Interactive Feedback To The Patient Family Member S Or Caregiver S When Performed First Hour |
| 96133-CPT | Low | Nrpsyc Tst Eval Phys Qhp Ea, Neuropsychological Testing Evaluation Services By Physician Or Other Qualified Health Care Professional Including Integration Of Patient Data Interpretation Of Standardized Test Results And Clinical Data 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 96133. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96133 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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