CPT code 96112: Developmental testing, initial hour2026 Medicare rate & RVUs in Puerto Rico

In Puerto Rico, Medicare pays $125.57 for 96112 in the office and $107.00 when it’s performed in a hospital or facility.

Check a contract rate as a % of Medicare · 96112 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 96112 covers

A physician or other qualified health care professional uses standardized developmental measures and clinical observation to assess areas such as motor skills, language, cognition, social functioning, memory, or executive function. The service is commonly performed in a pediatric, developmental, psychology, or rehabilitation setting when a child’s development needs a more complete evaluation than a brief screening can provide. The clinician interprets the results and prepares a report.

Report 96112 for the initial hour of qualifying developmental testing. Documentation should identify the assessment performed, the developmental domains evaluated, the clinician’s work, and the interpretation and report. When additional qualifying testing time is supported, report it with 96113, the add-on code for additional time. Medicare physician fee schedule valuation is available by setting; the submitted service and setting determine the applicable schedule amount.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Puerto Rico compares for 96112

Across 109 of 109 payment localities, the office rate for 96112 runs from $118.04 in Arkansas to $168.19 in Alaska. Puerto Rico pays $125.57. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

96112 rates by state

Office rate range in each state. Select a state to see its payment localities.

See 96112 in every payment locality

How the 96112 rate is calculated

Each of 96112’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 96112

96112 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

Codes related to 96112

Related codes aren’t interchangeable: bill the code that matches the service performed.

How 96112 has changed in Puerto Rico

Price 96112 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

• Aceitunas
• Adjuntas
• Aguada
• Aguadilla
• Aguas Buenas
• Aguas Claras
• Aguilita
• Aibonito

Browse all communities in Puerto Rico

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates