How much does Medicare pay for CPT 96127?

Medicare allowed an average of $4.47 per service and paid $3.13 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $23.14, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 96127?

Assessment of emotional or behavioral problems. It was billed 833,787 times to 446,254 Medicare beneficiaries by 9,200 providers in 2024.

Does 96127 pay differently in an office than a hospital?

Yes. The allowed amount averaged $4.47 in an office setting and $4.15 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 96127 most?

Nurse Practitioner, with 199,411 services from 2,558 clinicians. Next are Family Practice, Internal Medicine, Physician Assistant.

CPT 96127

Assessment of emotional or behavioral problems

$4.47Medicare-allowed amount per service, averaged across 833,787 services

Providers submitted

$23.14

Asking price, not received

Medicare allowed

$4.47

The fee schedule figure

Medicare paid

$3.13

Balance is patient coinsurance

Providers submitted an average of $23.14 for this code and Medicare allowed $4.47 — 5.2× 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 $3.13 (70%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $4.47
Hospital / facility: $4.15

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. 833,080 services were billed in an office setting and 707 in a facility.

Services: 833,787
Beneficiaries: 446,254
Providers billing it: 9,200
Total allowed: $3,727,028

What Medicare pays for CPT 96127

Across 833,787 services billed by 9,200 providers to 446,254 beneficiaries, Medicare allowed an average of $4.47 per service. That is 1.9 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 96127

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	199,411	101,162	$4.33	2,558
Family Practice	136,197	96,173	$4.43	2,412
Internal Medicine	114,972	72,234	$4.77	1,378
Physician Assistant	64,109	32,957	$4.38	915
Anesthesiology	60,986	14,754	$4.35	105
Pain Management	59,664	16,029	$4.35	120
Obstetrics & Gynecology	32,378	24,613	$5.07	498
Psychiatry	30,359	10,454	$4.29	240
Neurology	23,939	16,584	$4.78	165
Physical Medicine and Rehabilitation	21,644	7,337	$4.52	78
Interventional Pain Management	21,205	9,072	$4.20	76
Hematology-Oncology	10,395	6,685	$5.27	66
Licensed Clinical Social Worker	7,604	3,702	$3.26	37
General Practice	6,394	3,367	$4.44	52
Psychologist, Clinical	6,230	6,044	$5.66	5

96127 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
Texas	83,677	$4.30	$3.19	747
North Carolina	63,546	$4.17	$2.88	1,241
Pennsylvania	63,021	$4.56	$3.26	278
New York	51,006	$5.24	$2.95	574
Delaware	48,937	$4.30	$3.36	109
California	44,556	$5.18	$3.21	459
Maryland	39,566	$4.90	$3.02	485
New Jersey	35,962	$5.17	$3.06	327
Florida	29,764	$4.61	$3.14	359
Tennessee	27,410	$3.92	$2.75	316
Oklahoma	24,215	$3.98	$3.20	138
Alabama	22,851	$3.70	$3.09	130
Indiana	19,405	$4.02	$3.03	207
Michigan	19,062	$4.41	$3.12	334
Washington	18,419	$4.69	$3.12	232
Colorado	18,184	$4.69	$3.06	190
Arizona	17,104	$4.41	$3.04	176
Louisiana	14,941	$4.02	$2.81	148
Nevada	14,590	$4.47	$3.03	161
Illinois	14,267	$4.70	$3.12	262
Arkansas	13,905	$3.80	$3.22	95
Georgia	13,878	$4.11	$3.16	139
Iowa	11,826	$4.01	$2.99	140
Ohio	11,641	$4.12	$3.01	191
Oregon	11,450	$4.53	$3.02	184
Virginia	10,503	$4.65	$3.04	202
Massachusetts	9,949	$4.85	$3.07	193
Connecticut	8,401	$5.10	$2.96	163
Mississippi	7,062	$3.88	$2.86	89
Idaho	6,760	$4.01	$2.58	76
South Carolina	6,469	$4.14	$3.16	69
Utah	5,847	$4.19	$3.01	85
Kentucky	5,734	$4.01	$2.90	88
New Mexico	4,654	$4.24	$3.04	69
Minnesota	4,586	$4.43	$2.93	82
Nebraska	4,343	$3.51	$2.56	64
Montana	3,627	$4.53	$2.95	34
New Hampshire	3,104	$4.71	$2.87	48
North Dakota	2,514	$4.42	$2.83	22
Wisconsin	2,465	$4.17	$2.84	46
Kansas	2,337	$4.10	$3.09	36
Alaska	1,963	$4.66	$2.68	23
Missouri	1,945	$4.22	$3.17	37
West Virginia	1,922	$4.09	$2.65	29
District of Columbia	1,468	$5.39	$3.18	27
Hawaii	1,358	$5.06	$2.58	20
Rhode Island	1,338	$4.64	$3.08	24
Wyoming	656	$4.52	$3.27	15
Vermont	637	$4.29	$2.73	14
Maine	613	$4.01	$2.68	11
South Dakota	197	$4.36	$2.80	8
Guam	91	$5.07	$2.93	1
Puerto Rico	41	$4.59	$2.30	2
ZZ	20	$4.27	$2.32	1

Related codes

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
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.