How much does Medicare pay for CPT 96116?

Medicare allowed an average of $88.32 per service and paid $67.48 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $260.95, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 96116?

Exam of neurobehavioral status, first hour. It was billed 128,682 times to 118,209 Medicare beneficiaries by 1,931 providers in 2024.

Does 96116 pay differently in an office than a hospital?

Yes. The allowed amount averaged $90.63 in an office setting and $78.20 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 96116 most?

Psychologist, Clinical, with 82,753 services from 1,376 clinicians. Next are Neurology, Internal Medicine, Family Practice.

CPT 96116

Exam of neurobehavioral status, first hour

$88.32Medicare-allowed amount per service, averaged across 128,682 services

Providers submitted

$260.95

Asking price, not received

Medicare allowed

$88.32

The fee schedule figure

Medicare paid

$67.48

Balance is patient coinsurance

Providers submitted an average of $260.95 for this code and Medicare allowed $88.32 — 3.0× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $67.48 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $90.63
Hospital / facility: $78.20

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 104,816 services were billed in an office setting and 23,866 in a facility.

Services: 128,682
Beneficiaries: 118,209
Providers billing it: 1,931
Total allowed: $11,365,194

What Medicare pays for CPT 96116

Across 128,682 services billed by 1,931 providers to 118,209 beneficiaries, Medicare allowed an average of $88.32 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 96116

Specialty	Services	Beneficiaries	Avg allowed	Providers
Psychologist, Clinical	82,753	80,888	$87.07	1,376
Neurology	16,285	14,323	$92.79	209
Internal Medicine	11,736	10,825	$93.81	159
Family Practice	6,403	3,779	$91.64	56
Nurse Practitioner	4,684	3,538	$75.67	52
Psychiatry	1,528	882	$87.52	22
Emergency Medicine	1,249	141	$90.79	2
General Practice	1,081	1,032	$93.31	10
Neuropsychiatry	812	775	$88.73	13
Physician Assistant	788	758	$74.37	12
Cardiology	456	444	$99.84	3
Geriatric Medicine	196	175	$79.81	5
Anesthesiology	190	180	$95.78	3
Undefined Physician type	126	126	$100.33	1
General Surgery	116	115	$85.85	1

96116 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	24,846	$91.36	$67.59	282
Florida	11,011	$89.94	$68.29	167
Texas	10,023	$85.95	$66.28	135
New York	9,508	$95.61	$66.74	158
Michigan	5,170	$86.31	$65.10	84
Illinois	4,760	$89.22	$66.04	66
New Jersey	4,740	$96.07	$65.73	70
Ohio	3,701	$82.87	$65.24	66
Arizona	3,574	$86.93	$67.50	54
Maryland	3,542	$93.35	$69.23	43
Missouri	3,135	$85.92	$67.79	32
Virginia	3,132	$87.04	$63.39	47
Wisconsin	2,726	$81.66	$63.47	57
North Carolina	2,680	$82.07	$63.30	46
Massachusetts	2,678	$90.70	$66.97	53
Alabama	2,434	$78.61	$63.45	36
Pennsylvania	2,397	$85.29	$64.93	56
Georgia	2,161	$87.69	$66.02	28
Nevada	2,118	$86.55	$67.52	21
Minnesota	2,002	$86.04	$66.94	40
Colorado	1,881	$87.28	$65.49	34
Indiana	1,687	$82.31	$66.65	23
Tennessee	1,492	$81.95	$64.55	22
Washington	1,488	$88.33	$64.40	35
Iowa	1,359	$79.44	$63.72	20
Oregon	1,298	$88.52	$64.71	22
Kentucky	961	$85.58	$67.55	24
North Dakota	954	$76.22	$56.24	9
Kansas	930	$83.74	$62.99	10
Arkansas	888	$77.51	$61.61	10
Connecticut	885	$88.93	$62.61	27
Nebraska	733	$83.79	$67.82	9
Utah	727	$82.66	$63.75	11
Mississippi	650	$82.93	$64.93	7
South Carolina	628	$86.26	$66.82	11
Louisiana	624	$83.39	$65.53	16
New Hampshire	609	$89.45	$64.49	10
New Mexico	549	$86.89	$66.11	15
District of Columbia	479	$95.87	$67.89	7
West Virginia	432	$82.76	$64.50	10
Vermont	431	$85.62	$62.65	5
Delaware	372	$89.81	$71.11	2
Oklahoma	371	$85.91	$69.19	5
Montana	370	$83.06	$64.89	9
Maine	262	$73.73	$57.52	8
South Dakota	226	$81.65	$61.76	4
Hawaii	167	$90.47	$64.91	4
Wyoming	167	$87.77	$63.67	1
Idaho	136	$77.14	$60.21	5
Rhode Island	128	$89.06	$67.72	3
XX	120	$97.36	$72.02	1
Puerto Rico	104	$89.53	$66.53	5
Alaska	83	$123.24	$65.75	4
Guam	78	$97.09	$70.70	1
ZZ	75	$75.46	$56.01	1

Related codes

96127Assessment of emotional or behavioral problems$4.47
96133Evaluation of neuropsychological test$92.52
96139Administration of psychological or neuropsychological test by technici$34.56
96137Administration of psychological or neuropsychological test$35.38
96132Evaluation of neuropsychological test$121.64
96160Administration and interpretation of patient-focused health risk asses$2.79
96138Administration of psychological or neuropsychological test by technici$33.17
96136Administration of psychological or neuropsychological test$38.12
96130Evaluation of psychological test$112.99
96131Evaluation of psychological test$82.62
96165Treatment of behavior impacting health in group setting$4.02
96121Exam of neurobehavioral status$71.55

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.