CPT 96202 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 • Behavior Management Services |
| Common Place of Service | • 11 - Office • 22 - On Campus Outpatient Hospital • None |
| Common Modifiers | • None • 95 - Telemedicine - audio and video • 59 - Distinct Procedural Service |
| Complexity Level | Low |
National average reimbursement for CPT 96202 by major payers:
$29.65
$23.59
$24.11
$48.78
| 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 96202 | ||||||
United | 96202 | $31.47 | 1639106693 - MICHELLE FIELD | 205029504 - (IL) MICHELLE A FIELD MD SC | IL | Psychiatry Physician (2084P0800X) |
United | 96202 | $18.68 | 1679093413 - MANSI SHAH | 223682760 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96202 | $31.47 | 1093164238 - MARTIN GREENWALD | 363149833 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 96202 | $42.20 | 1386969079 - ADAM WALLACE | 363907436 - ROCKFORD HEALTH PHYSICIANS | MN | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 96202 | $24.90 | 1679526784 - ELTON SMITH | 853384814 | IL | Psychiatry Physician (2084P0800X) |
United | 96202 | $22.65 | 1376063370 - ABBY FREDRICKSON | 411765832 - HEALTHEAST MEDICAL RESEARCH INSTITUTE | IL | Psychiatry Physician (2084P0800X) |
United | 96202 | $23.71 | 1679526784 - ELTON SMITH | 541217184 - SENTARA MEDICAL GROUP | IL | Psychiatry Physician (2084P0800X) |
United | 96202 | $23.71 | 1033347125 - DAVID HANRAHAN | 540505979 - VALLEY HEALTH SYSTEM | IL | Psychiatry Physician (2084P0800X) |
United | 96202 | $25.18 | 1285650408 - MEHMET DOKUCU | 20222140 - MARY HITCHCOCK MEMORIAL HOSPITAL | NH | Psychiatry Physician (2084P0800X) |
United | 96202 | $24.90 | 1558314583 - NANCY PECEN | 824934016 - (IL) NANCEY E PECEN MD SC | IL | Psychiatry Physician (2084P0800X) |
United | 96202 | $24.90 | 1730263617 - MARK ALTER | 853384814 | PA | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96202 | $28.73 | 1063891232 - BIKRAM SHARMA | 364340137 - (IL) SAINT ANTHONY HEALTH AFFILIATES | IL | Psychiatry Physician (2084P0800X) |
United | 96202 | $21.39 | 1245674159 - KHOA NGUYEN | 223500420 - CENTER FOR FAMILY GUIDANCE, PC | FL | Psychiatry Physician (2084P0800X) |
United | 96202 | $40.91 | 1346289980 - RIFKI GOLDIN MERTDOGAN | 362657618 - (IL) DUPAGE MEDICAL GROUP LTD | IL | Psychiatry Physician (2084P0800X) |
United | 96202 | $23.71 | 1962674820 - LISA BURCKHARTZMEYER | 362596200 - (IL) SINNISSIPPI CENTERS INC | 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 96202 vs. Other Behavior Management Services Codes
The CPT 96202 code is part of the Medicine Services and Procedures services used for Behavior Management Services. 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 96202 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 |
|---|---|---|
| 96165-CPT | Low | Level 4 Hospital Emergency Department Visit Provided In A Type B Emergency Department; (The Ed Must Meet At Least One Of The Following Requirements: (1) It Is Licensed By The State In Which It Is Located Under Applicable State Law As An Emergency Room Or Emergency Department; (2) It Is Held Out To The Public (By Name, Posted Signs, Advertising, Or Other Means) As A Place That Provides Care For Emergency Medical Conditions On An Urgent Basis Without Requiring A Previously Scheduled Appointment; O |
| 96167-CPT | Low | Level 5 Hospital Emergency Department Visit Provided In A Type B Emergency Department; (The Ed Must Meet At Least One Of The Following Requirements: (1) It Is Licensed By The State In Which It Is Located Under Applicable State Law As An Emergency Room Or Emergency Department; (2) It Is Held Out To The Public (By Name, Posted Signs, Advertising, Or Other Means) As A Place That Provides Care For Emergency Medical Conditions On An Urgent Basis Without Requiring A Previously Scheduled Appointment; O |
| 96168-CPT | Low | Initial Physician Evaluation And Management Of A Diabetic Patient With Diabetic Sensory Neuropathy Resulting In A Loss Of Protective Sensation (Lops) Which Must Include: (1) The Diagnosis Of Lops, (2) A Patient History, (3) A Physical Examination That Consists Of At Least The Following Elements: (A) Visual Inspection Of The Forefoot, Hindfoot, And Toe Web Spaces, (B) Evaluation Of A Protective Sensation, (C) Evaluation Of Foot Structure And Biomechanics, (D) Evaluation Of Vascular Status And Ski |
| 96202-CPT | Low | Multiple-Family Group Behavior Management/Modification Training For Parent(S)/Guardian(S)/Caregiver(S) Of Patients With A Mental Or Physical Health Diagnosis, Administered By Physician Or Other Qualified Health Care Professional (Without The Patient Present), Face-To-Face With Multiple Sets Of Parent(S)/Guardian(S)/Caregiver(S); Initial 60 Minutes |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96202. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96202 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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