CPT 96203 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 | • 19 - Off Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • 95 - Telemedicine - audio and video • PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
National average reimbursement for CPT 96203 by major payers:
$7.72
$6.05
$6.43
$19.22
| 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 96203 | ||||||
United | 96203 | $8.09 | 1124084967 - SANDEEP GAONKAR | 450478340 - (IL) CONVENTIONS PSYCHIATRY COUNSELING PC | IL | Psychiatry Physician (2084P0800X) |
United | 96203 | $8.09 | 1013112143 - PETER NICHOLS | 621658515 - (IL) BHC STREAMWOOD HOSPITAL INC | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96203 | $6.09 | 1942266580 - MARIA LIQUETE | 621490616 - BLUE RIDGE MEDICAL MANAGEMENT CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 96203 | $4.80 | 1093243149 - KRISTIN ROSSEAU | 871959655 - (IL) CHICAGO BH HOSPITAL LLC | IL | Psychiatry Physician (2084P0800X) |
United | 96203 | $6.13 | 1316032147 - RONALD ST. HILL | 562576649 - EHAB YACOUB, MD INC. DBA BRAIN HEALTH USA | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96203 | $5.17 | 1871907774 - ODAY ALSARRAF | 561509260 - REX HOSPITAL INC | IL | Psychiatry Physician (2084P0800X) |
United | 96203 | $6.40 | 1285749077 - KARLENE GOODMAN | 1285749077 - (IL) KARLENE GOODMAN | IL | Psychiatry Physician (2084P0800X) |
United | 96203 | $5.44 | 1689166027 - ANIRUDDHA DEKA | 863386097 - (IL) MOSAIC COUNSELING & WELLNESS, LLC | IL | Psychiatry Physician (2084P0800X) |
United | 96203 | $12.53 | 1245252303 - MARY FAHRMEIER | 910844563 | VA | Psychiatry Physician (2084P0800X) |
United | 96203 | $6.48 | 1437438249 - KAPIL AEDMA | 460787784 | MO | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96203 | $11.41 | 1730385618 - CABRINI SUTHERLAND | 561026666 - SURGICAL SPECIALISTS OF CHARLOTTE, PA | NC | Surgical Critical Care Physician (2086S0102X) |
United | 96203 | $8.09 | 1689623472 - TALAT GHAUS | 863624508 - (IL) ASCEND TMS LLC | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96203 | $6.09 | 1629046735 - AQEEL KHAN | 461345666 - OXFORD INTEGRATED HEALTH SOLUTIONS PLLC | CT | Psychiatry Physician (2084P0800X) |
United | 96203 | $10.77 | 1639691090 - KELLY RHODES | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | IL | Psychiatry Physician (2084P0800X) |
United | 96203 | $6.40 | 1548322639 - J RICHARD GALLAGHER | 1548322639 - (IL) J RICHARD GALLAGHER | 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 96203 vs. Other Behavior Management Services Codes
The CPT 96203 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 96203 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 |
| 96203-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); Each Additional 15 Minutes (List Separately In Addition To Code For Primary Service) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96203. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96203 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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