How much does Medicare pay for CPT 96121?

Medicare allowed an average of $71.55 per service and paid $55.78 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $222.86, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 96121?

Exam of neurobehavioral status, each additional hour. It was billed 28,643 times to 21,991 Medicare beneficiaries by 423 providers in 2024.

Does 96121 pay differently in an office than a hospital?

Yes. The allowed amount averaged $73.42 in an office setting and $66.15 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 96121 most?

Psychologist, Clinical, with 27,912 services from 409 clinicians. Next are Neurology, Psychiatry, Optometry.

CPT 96121

Exam of neurobehavioral status, each additional hour

$71.55Medicare-allowed amount per service, averaged across 28,643 services

Providers submitted

$222.86

Asking price, not received

Medicare allowed

$71.55

The fee schedule figure

Medicare paid

$55.78

Balance is patient coinsurance

Providers submitted an average of $222.86 for this code and Medicare allowed $71.55 — 3.1× 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 $55.78 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $73.42
Hospital / facility: $66.15

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. 21,278 services were billed in an office setting and 7,365 in a facility.

Services: 28,643
Beneficiaries: 21,991
Providers billing it: 423
Total allowed: $2,049,407

What Medicare pays for CPT 96121

Across 28,643 services billed by 423 providers to 21,991 beneficiaries, Medicare allowed an average of $71.55 per service. That is 1.3 services per beneficiary, so this is a code patients typically receive more than once. 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 96121

Specialty	Services	Beneficiaries	Avg allowed	Providers
Psychologist, Clinical	27,912	21,293	$71.52	409
Neurology	590	588	$73.08	9
Psychiatry	53	52	$70.63	2
Optometry	47	17	$73.00	1
Neuropsychiatry	41	41	$71.35	2

96121 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	6,825	$70.52	$54.79	65
Texas	4,568	$73.11	$56.78	45
Florida	3,028	$72.91	$56.94	56
Arizona	1,716	$70.59	$56.04	19
Massachusetts	1,429	$68.65	$51.98	14
New York	1,057	$77.31	$56.02	24
Illinois	951	$74.06	$56.88	13
Michigan	886	$72.11	$57.48	11
Colorado	826	$74.11	$57.56	11
North Carolina	728	$70.58	$53.69	15
Virginia	654	$65.65	$49.08	13
Oregon	627	$73.61	$53.38	7
Maryland	594	$69.34	$53.87	14
New Jersey	486	$78.12	$57.42	10
South Carolina	446	$71.44	$57.33	3
Tennessee	378	$71.15	$54.82	2
Wisconsin	372	$64.61	$50.57	9
Ohio	327	$72.09	$58.37	8
District of Columbia	229	$75.04	$53.01	6
Connecticut	205	$71.94	$53.86	6
Iowa	201	$66.98	$52.68	5
Pennsylvania	194	$70.18	$52.78	9
Indiana	173	$70.74	$55.59	4
Nevada	167	$71.71	$58.20	5
Mississippi	154	$64.76	$52.35	3
Georgia	143	$68.85	$53.96	2
New Mexico	141	$71.17	$53.99	2
Minnesota	132	$69.29	$53.59	7
Idaho	112	$63.02	$51.31	2
Wyoming	105	$71.56	$56.76	1
Arkansas	102	$59.73	$51.65	2
Washington	93	$70.04	$55.02	4
Montana	92	$68.19	$54.16	2
Nebraska	79	$71.32	$58.25	4
Maine	76	$63.25	$51.26	2
Kentucky	61	$70.82	$58.91	2
New Hampshire	44	$66.00	$49.44	2
Hawaii	42	$75.35	$55.76	2
Delaware	32	$73.63	$54.57	1
Missouri	26	$70.51	$51.41	1
Louisiana	24	$72.23	$56.23	2
Alabama	19	$63.30	$52.96	1
Oklahoma	18	$71.20	$58.35	1
Puerto Rico	17	$73.68	$50.10	1
Vermont	14	$72.36	$58.24	1
West Virginia	14	$71.79	$58.65	1
South Dakota	13	$63.68	$45.19	1
North Dakota	12	$63.85	$51.20	1
Alaska	11	$102.34	$53.30	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
96116Exam of neurobehavioral status$88.32
96130Evaluation of psychological test$112.99
96131Evaluation of psychological test$82.62
96165Treatment of behavior impacting health in group setting$4.02

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.