CPT 96136 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 |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 95 - Telemedicine - audio and video |
| Complexity Level | Moderate |
National average reimbursement for CPT 96136 by major payers:
$53.23
$55.71
$52.98
$68.59
| 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 96136 | ||||||
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CPT 96136 vs. Other Central Nervous System Assessments/Tests (eg, Neuro-Cognitive, Mental Status, Speech Testing) Codes
The CPT 96136 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 96136 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 |
|---|---|---|
| 96116 | 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) |
| 96121 | 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 Pro- Fessional Both Face-To-Face Time With The Patientand Time Interpreting Test Results And Preparing The Report; Each Additional Hour (List Separately In Addition To Code For Primary Procedure) |
| 96136 | Low | Psychological Or Neuropsychological Test Administration & Scoring By Physician/Other Qhcp, 2 Or More Tests, Any Method; First 30 Minutes Synchronous Telemed Svc Rendered Real Time Audio |
| 96137 | Low | Psychological Or Neuropsychological Test Admini- Stration And Scoring By Physician Or Other Quali- Fied Health Care Professional Two Or More Tests Any Method; Each Additional 30 Minutes (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 96136. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96136 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 |
|---|