How much does Medicare pay for CPT 96138?

Medicare allowed an average of $33.17 per service and paid $25.74 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $112.31, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 96138?

Administration of psychological or neuropsychological test by technician, first 30 minutes. It was billed 195,867 times to 149,684 Medicare beneficiaries by 2,323 providers in 2024.

Does 96138 pay differently in an office than a hospital?

Yes. The allowed amount averaged $33.09 in an office setting and $34.45 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 96138 most?

Psychologist, Clinical, with 65,279 services from 1,023 clinicians. Next are Neurology, Nurse Practitioner, Internal Medicine.

CPT 96138

Administration of psychological or neuropsychological test by technician, first 30 minutes

$33.17Medicare-allowed amount per service, averaged across 195,867 services

Providers submitted

$112.31

Asking price, not received

Medicare allowed

$33.17

The fee schedule figure

Medicare paid

$25.74

Balance is patient coinsurance

Providers submitted an average of $112.31 for this code and Medicare allowed $33.17 — 3.4× 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 $25.74 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $33.09
Hospital / facility: $34.45

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 183,901 services were billed in an office setting and 11,966 in a facility.

Services: 195,867
Beneficiaries: 149,684
Providers billing it: 2,323
Total allowed: $6,496,908

What Medicare pays for CPT 96138

Across 195,867 services billed by 2,323 providers to 149,684 beneficiaries, Medicare allowed an average of $33.17 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 96138

Specialty	Services	Beneficiaries	Avg allowed	Providers
Psychologist, Clinical	65,279	62,524	$33.13	1,023
Neurology	27,577	25,682	$34.21	361
Nurse Practitioner	18,656	10,883	$27.10	212
Internal Medicine	14,426	13,594	$36.13	176
Interventional Pain Management	13,532	5,215	$33.02	59
Psychiatry	13,111	3,852	$35.89	34
Anesthesiology	10,964	6,130	$33.25	76
Pain Management	8,974	4,948	$33.20	74
Family Practice	7,068	6,383	$33.98	140
Physical Medicine and Rehabilitation	4,932	2,292	$35.07	40
Physician Assistant	4,893	3,235	$27.63	62
General Practice	1,661	957	$37.31	13
Geriatric Medicine	818	775	$33.38	7
Diagnostic Radiology	817	488	$40.20	2
Neuropsychiatry	569	544	$38.75	6

96138 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	28,533	$38.37	$26.16	185
Texas	25,603	$32.02	$25.75	341
Florida	22,963	$32.13	$26.31	209
Tennessee	11,075	$26.41	$23.34	64
Georgia	8,836	$31.46	$25.30	93
New York	8,472	$39.50	$25.90	119
Arizona	7,486	$32.04	$25.99	96
Maryland	5,252	$35.21	$24.72	66
Pennsylvania	4,846	$31.79	$25.75	80
Virginia	4,736	$34.37	$25.87	55
Illinois	4,506	$33.62	$25.89	75
Missouri	4,433	$30.58	$24.79	59
North Carolina	4,296	$30.57	$25.59	52
Oklahoma	3,945	$28.56	$25.13	48
Massachusetts	3,914	$36.74	$26.07	54
Ohio	3,686	$30.90	$26.12	53
Washington	3,685	$37.14	$26.65	20
Nevada	3,234	$31.14	$24.74	46
New Jersey	3,164	$37.73	$26.13	59
Indiana	2,567	$30.10	$26.12	39
Arkansas	2,524	$27.94	$25.86	24
Michigan	2,391	$32.35	$26.24	50
Wisconsin	2,327	$31.87	$26.54	44
Colorado	2,183	$34.83	$26.16	40
Minnesota	2,061	$34.60	$26.71	46
South Carolina	1,515	$30.96	$25.85	26
Alabama	1,279	$29.09	$26.14	25
Oregon	1,218	$33.07	$24.85	18
Kentucky	1,169	$29.73	$25.05	15
Utah	1,023	$30.51	$24.50	17
Kansas	985	$30.53	$25.73	10
Connecticut	967	$33.07	$23.80	12
Louisiana	961	$29.69	$26.37	25
District of Columbia	924	$40.15	$26.87	5
Nebraska	912	$29.68	$25.60	17
Delaware	874	$31.46	$24.27	17
Vermont	865	$33.30	$24.81	7
North Dakota	859	$33.74	$26.75	11
Mississippi	720	$28.80	$25.61	7
Iowa	719	$30.54	$26.43	15
New Mexico	634	$30.18	$25.11	13
West Virginia	588	$29.77	$26.53	11
Wyoming	554	$33.15	$25.85	4
Idaho	540	$26.39	$22.81	6
Hawaii	435	$37.19	$26.47	5
New Hampshire	289	$32.73	$26.70	7
Montana	273	$33.22	$26.03	8
South Dakota	270	$33.01	$26.51	8
Rhode Island	227	$34.89	$26.69	9
Alaska	122	$36.21	$26.81	3
Guam	82	$40.18	$26.88	1
Maine	80	$31.92	$26.81	3
ZZ	65	$28.93	$26.79	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
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.