CPT 96137 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 • AH • 95 - Telemedicine - audio and video |
| Complexity Level | Low |
National average reimbursement for CPT 96137 by major payers:
$47.98
$51.21
$48.26
$63.35
| 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 96137 | ||||||
United | 96137 | $41.27 | 1033199336 - ANDREW PUNDY | 1033199336 - (IL) ANDREW PUNDY | IL | Psychiatry Physician (2084P0800X) |
United | 96137 | $58.31 | 1760412621 - RHONDA LAMPEN | 454370919 | WI | Psychiatry Physician (2084P0800X) |
United | 96137 | $41.27 | 1962664789 - JAMIE EVANS | 331075317 - NCHMD INC | NC | Psychiatry Physician (2084P0800X) |
United | 96137 | $39.31 | 1124016902 - GONCHIGARI NARAYANA | 371314625 - (IL) GONCHIGARI NARAYANA | IL | Psychiatry Physician (2084P0800X) |
United | 96137 | $40.56 | 1831389907 - CHRISTINE MICHAUD | 455421326 - (IL) C TIA MICHAUD MD PC | IL | Psychiatry Physician (2084P0800X) |
United | 96137 | $49.84 | 1578785432 - RICHARD JACONETTE | 272583676 - ROCKFORD PSYCHIATRIC SERVICES, SC | IL | Psychiatry Physician (2084P0800X) |
United | 96137 | $39.31 | 1063593721 - GARY CASACCIO | 363495231 | IL | Psychiatry Physician (2084P0800X) |
United | 96137 | $41.27 | 1710470257 - ALAN AKIRA | 871959655 - (IL) CHICAGO BH HOSPITAL LLC | IL | Psychiatry Physician (2084P0800X) |
United | 96137 | $41.27 | 1316155534 - MUHAMMAD AZHAR | 260242756 - (IL) BEHAVIORAL HEALTH AND EDUCATION SPECIALISTS INC | IL | Psychiatry Physician (2084P0800X) |
United | 96137 | $48.70 | 1528325578 - AMBER MAY | 923018752 - (IL) ORION TMS PLLC | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96137 | $39.31 | 1063972404 - MAANASA BANDLA | 203639329 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96137 | $29.13 | 1881012235 - LAUREN PREST | 910843135 | MN | Psychiatry Physician (2084P0800X) |
United | 96137 | $71.84 | 1609023068 - LAURA MURPHY | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 96137 | $41.27 | 1386682144 - JOSEPH BECK | 863386097 - (IL) MOSAIC COUNSELING & WELLNESS, LLC | IL | Psychiatry Physician (2084P0800X) |
United | 96137 | $41.27 | 1316032147 - RONALD ST. HILL | 562576649 - EHAB YACOUB, MD INC. DBA BRAIN HEALTH USA | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
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 96137 vs. Other Central Nervous System Assessments/Tests (eg, Neuro-Cognitive, Mental Status, Speech Testing) Codes
The CPT 96137 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 96137 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-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) |
| 96121-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 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-CPT | 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-CPT | 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 96137. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96137 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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