CPT code 96113: Developmental testing, each additional 30 minutes2026 Medicare rate & RVUs in Hawaii, Guam, HI
Report this add-on for each additional 30 minutes of physician or qualified health professional developmental test administration beyond the initial service.
In Hawaii, Guam, HI, Medicare pays $57.93 for 96113 in the office and $45.40 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 96113 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 96113 covers
A physician or other qualified health care professional uses this service for additional time administering and evaluating standardized developmental tests. Testing may assess a child’s language, motor, cognitive, social, memory, or adaptive functioning when developmental delay or another developmental concern prompts a formal evaluation. It can occur in an office, clinic, or other setting where the clinician performs the assessment with the patient and, when relevant, family members.
Report 96113 only with 96112, the primary developmental-testing service, for qualifying time beyond its initial hour. The record should identify the testing performed, the functions assessed, total service time, and the scoring, interpretation, and report supporting the additional work. CMS classifies 96113 as an add-on code: it cannot be billed alone, and payment is within the primary service’s global-period context.
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 Hawaii, Guam, HI compares for 96113
Across 109 of 109 payment localities, the office rate for 96113 runs from $53.32 in Arkansas to $76.10 in Alaska. Hawaii, Guam, HI pays $57.93. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Hawaii, Guam, HI · this page$57.93
- Los Angeles, CA · California$60.36+$2.43
- Washington, DC area · District of Columbia$61.23+$3.30
- Miami, FL · Florida$58.32+$0.39
- Chicago, IL · Illinois$57.76−$0.17
- Manhattan, NY · New York$61.83+$3.90
- Alaska · Alaska$76.10+$18.17
Other areas in Hawaii first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $53.63 | $43.99 |
| ArkansasArkansas | $53.32 | $43.85 |
| ArizonaArizona | $55.46 | $44.78 |
| Bakersfield, CACalifornia | $58.03 | $45.95 |
| Chico, CACalifornia | $57.88 | $45.80 |
| El Centro, CACalifornia | $57.88 | $45.80 |
| Fresno, CACalifornia | $57.88 | $45.80 |
| Hanford, CACalifornia | $57.88 | $45.80 |
| Madera, CACalifornia | $57.88 | $45.80 |
| Merced, CACalifornia | $57.88 | $45.80 |
| Modesto, CACalifornia | $57.88 | $45.80 |
| Napa, CACalifornia | $63.27 | $48.74 |
| Oxnard, CACalifornia | $59.80 | $46.77 |
| Redding, CACalifornia | $57.88 | $45.80 |
| Rest of CaliforniaCalifornia | $57.88 | $45.80 |
| Riverside, CACalifornia | $58.23 | $46.15 |
| Sacramento, CACalifornia | $59.71 | $46.89 |
| Salinas, CACalifornia | $59.45 | $46.68 |
| San Diego, CACalifornia | $60.02 | $46.84 |
| Marin County, CACalifornia | $65.96 | $50.42 |
| San Francisco, CACalifornia | $65.93 | $50.39 |
| San Benito County, CACalifornia | $67.14 | $51.25 |
| Santa Clara County, CACalifornia | $67.01 | $51.11 |
| San Luis Obispo, CACalifornia | $58.58 | $46.03 |
| Santa Cruz, CACalifornia | $59.98 | $46.59 |
| Santa Maria, CACalifornia | $59.45 | $46.60 |
| Santa Rosa, CACalifornia | $60.54 | $47.01 |
| Stockton, CACalifornia | $57.88 | $45.80 |
| Vallejo, CACalifornia | $63.22 | $48.69 |
| Visalia, CACalifornia | $57.88 | $45.80 |
| Yuba City, CACalifornia | $57.88 | $45.80 |
| ColoradoColorado | $57.41 | $45.68 |
| ConnecticutConnecticut | $58.36 | $46.49 |
| DelawareDelaware | $56.01 | $45.12 |
| Fort Lauderdale, FLFlorida | $57.14 | $45.97 |
| Rest of FloridaFlorida | $55.90 | $45.36 |
| Atlanta, GAGeorgia | $56.69 | $45.49 |
| Rest of GeorgiaGeorgia | $54.54 | $44.71 |
| IowaIowa | $54.12 | $44.03 |
| IdahoIdaho | $54.28 | $44.14 |
| East St. Louis, ILIllinois | $55.82 | $45.68 |
| Rest of IllinoisIllinois | $55.25 | $45.19 |
| Suburban Chicago, ILIllinois | $57.60 | $46.28 |
| IndianaIndiana | $54.40 | $44.19 |
| KansasKansas | $54.05 | $44.08 |
| KentuckyKentucky | $54.21 | $44.41 |
| New Orleans, LALouisiana | $55.28 | $44.91 |
| Rest of LouisianaLouisiana | $54.19 | $44.43 |
| Metropolitan Boston, MAMassachusetts | $60.77 | $47.61 |
| Rest of MassachusettsMassachusetts | $57.40 | $45.79 |
| Baltimore area, MDMaryland | $58.17 | $46.34 |
| Rest of MarylandMaryland | $56.62 | $45.46 |
| Rest of MaineMaine | $54.43 | $44.28 |
| Southern Maine, MEMaine | $55.60 | $44.67 |
| Detroit, MIMichigan | $56.23 | $45.59 |
| Rest of MichiganMichigan | $54.82 | $44.76 |
| MinnesotaMinnesota | $55.88 | $44.54 |
| Metropolitan Kansas City, MOMissouri | $55.09 | $44.74 |
| Metropolitan St. Louis, MOMissouri | $55.33 | $44.84 |
| Rest of MissouriMissouri | $53.83 | $44.33 |
| MississippiMississippi | $53.58 | $44.09 |
| MontanaMontana | $56.11 | $45.09 |
| North CarolinaNorth Carolina | $54.66 | $44.37 |
| North DakotaNorth Dakota | $55.52 | $44.50 |
| NebraskaNebraska | $54.23 | $44.06 |
| New HampshireNew Hampshire | $56.66 | $45.19 |
| Northern New JerseyNew Jersey | $61.24 | $48.46 |
| Rest of New JerseyNew Jersey | $59.27 | $47.23 |
| New MexicoNew Mexico | $54.96 | $44.85 |
| NevadaNevada | $55.96 | $44.93 |
| NYC suburbs and Long Island, NYNew York | $62.55 | $49.44 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $59.62 | $47.55 |
| Queens, NYNew York | $62.01 | $48.99 |
| Rest of New YorkNew York | $55.00 | $44.53 |
| OhioOhio | $54.70 | $44.63 |
| OklahomaOklahoma | $54.14 | $44.30 |
| Portland, OROregon | $58.29 | $46.05 |
| Rest of OregonOregon | $55.75 | $44.77 |
| Metropolitan Philadelphia, PAPennsylvania | $57.68 | $46.20 |
| Rest of PennsylvaniaPennsylvania | $54.72 | $44.60 |
| Puerto RicoPuerto Rico | $56.28 | $45.13 |
| Rhode IslandRhode Island | $57.28 | $45.90 |
| South CarolinaSouth Carolina | $54.72 | $44.53 |
| South DakotaSouth Dakota | $55.45 | $44.43 |
| TennesseeTennessee | $54.16 | $44.14 |
| Austin, TXTexas | $57.03 | $45.36 |
| Beaumont, TXTexas | $54.57 | $44.54 |
| Brazoria, TXTexas | $56.06 | $45.13 |
| Dallas, TXTexas | $56.25 | $45.28 |
| Fort Worth, TXTexas | $56.10 | $45.24 |
| Galveston, TXTexas | $56.14 | $45.19 |
| Houston, TXTexas | $56.69 | $45.74 |
| Rest of TexasTexas | $55.18 | $44.72 |
| UtahUtah | $55.03 | $44.67 |
| VirginiaVirginia | $55.54 | $44.71 |
| Virgin Islands, VIUnited States Virgin Islands | $56.28 | $45.13 |
| VermontVermont | $55.45 | $44.54 |
| Rest of WashingtonWashington | $57.25 | $45.64 |
| King County, WAWashington | $61.58 | $48.06 |
| WisconsinWisconsin | $54.73 | $44.17 |
| West VirginiaWest Virginia | $54.40 | $44.82 |
| WyomingWyoming | $55.85 | $44.83 |
96113 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$53.32
$76.10
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $76.10 | 1 |
| AL | $53.63 | 1 |
| AR | $53.32 | 1 |
| AZ | $55.46 | 1 |
| CA | $57.88–$67.14 | 29 |
| CO | $57.41 | 1 |
| CT | $58.36 | 1 |
| DC | $61.23 | 1 |
| DE | $56.01 | 1 |
| FL | $55.90–$58.32 | 3 |
| GA | $54.54–$56.69 | 2 |
| GU | $57.93 | 1 |
| HI | $57.93 | 1 |
| IA | $54.12 | 1 |
| ID | $54.28 | 1 |
| IL | $55.25–$57.76 | 4 |
| IN | $54.40 | 1 |
| KS | $54.05 | 1 |
| KY | $54.21 | 1 |
| LA | $54.19–$55.28 | 2 |
| MA | $57.40–$60.77 | 2 |
| MD | $56.62–$61.23 | 3 |
| ME | $54.43–$55.60 | 2 |
| MI | $54.82–$56.23 | 2 |
| MN | $55.88 | 1 |
| MO | $53.83–$55.33 | 3 |
| MS | $53.58 | 1 |
| MT | $56.11 | 1 |
| NC | $54.66 | 1 |
| ND | $55.52 | 1 |
| NE | $54.23 | 1 |
| NH | $56.66 | 1 |
| NJ | $59.27–$61.24 | 2 |
| NM | $54.96 | 1 |
| NV | $55.96 | 1 |
| NY | $55.00–$62.55 | 5 |
| OH | $54.70 | 1 |
| OK | $54.14 | 1 |
| OR | $55.75–$58.29 | 2 |
| PA | $54.72–$57.68 | 2 |
| PR | $56.28 | 1 |
| RI | $57.28 | 1 |
| SC | $54.72 | 1 |
| SD | $55.45 | 1 |
| TN | $54.16 | 1 |
| TX | $54.57–$57.03 | 8 |
| UT | $55.03 | 1 |
| VA | $55.54–$61.23 | 2 |
| VI | $56.28 | 1 |
| VT | $55.45 | 1 |
| WA | $57.25–$61.58 | 2 |
| WI | $54.73 | 1 |
| WV | $54.40 | 1 |
| WY | $55.85 | 1 |
How the 96113 rate is calculated
Each of 96113’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.
How the rate is built · 96113
RVUs × geographic indexes × conversion factor
Work1.16
1.16 RVUs× 1.000 GPCI
Practice expense0.49
0.49 RVUs× 1.000 GPCI
Malpractice0.03
0.03 RVUs× 1.000 GPCI
Adjusted RVUs
1.6800
Conversion factor
$33.4009
Medicare rate
$56.11
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Hawaii, Guam, HI inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
12,750
- Code
- 96113
- Physician work
- 1.16
- Practice expense
- 0.49
- Malpractice
- 0.03
GPCI2026.csv
46
- Locality
- Hawaii, Guam, HI
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.16 | × 1.000 | 1.1600 |
| Practice expense | 0.49 | × 1.137 | 0.5571 |
| Malpractice | 0.03 | × 0.579 | 0.0174 |
| Total RVUs | 1.7345 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Hawaii, Guam, HI$57.93
Office: (1.16 × 1 + 0.49 × 1.137 + 0.03 × 0.579) × $33.4009 = $57.93
Facility: (1.16 × 1 + 0.16 × 1.137 + 0.03 × 0.579) × $33.4009 = $45.40
Payment rules and modifiers for 96113
The CMS indicators that decide how 96113 is paid alongside other services.
CMS payment indicators · 96113
Developmental testing, each additional 30 minutes
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
How 96113 has changed in Hawaii, Guam, HI
96113 · Office / nonfacility
$57.93
Effective 2026-10-01
The base rate is $2.96 higher than on 2025-10-01, moving from $54.97 to $57.93 (5.4%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$54.97changed to$57.93
- Conversion factor 32.3465 changed to 33.4009
- Practice expense RVU 0.45 changed to 0.49
- Malpractice RVU 0.04 changed to 0.03
- Practice expense GPCI 1.149 changed to 1.137
- Malpractice GPCI 0.561 changed to 0.579
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$61.72changed to$54.97
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 0.57 changed to 0.45
- Malpractice RVU 0.07 changed to 0.04
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$60.71changed to$61.72
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$62.04changed to$60.71
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 0.55 changed to 0.57
- Malpractice RVU 0.06 changed to 0.07
- Work GPCI 1.003 changed to 1.000
- Practice expense GPCI 1.146 changed to 1.149
- Malpractice GPCI 0.618 changed to 0.561
January 1, 2023
RVU23A
$63.14changed to$62.04
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 0.53 changed to 0.55
- Malpractice RVU 0.07 changed to 0.06
- Work GPCI 1.010 changed to 1.003
- Practice expense GPCI 1.143 changed to 1.146
- Malpractice GPCI 0.675 changed to 0.618
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$60.80changed to$63.14
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 0.47 changed to 0.53
- Malpractice RVU 0.05 changed to 0.07
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$64.98changed to$60.80
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 0.52 changed to 0.47
- Malpractice RVU 0.06 changed to 0.05
- Work GPCI 1.006 changed to 1.010
- Practice expense GPCI 1.144 changed to 1.143
- Malpractice GPCI 0.644 changed to 0.675
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$63.22changed to$64.98
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 0.48 changed to 0.52
- Malpractice RVU 0.07 changed to 0.06
- Work GPCI 1.001 changed to 1.006
- Practice expense GPCI 1.146 changed to 1.144
- Malpractice GPCI 0.614 changed to 0.644
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
No ratechanged to$63.22
Held through RVU19B, RVU19C, RVU19D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1, RVU18B, RVU18C, RVU18D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $57.93 | $45.40 | RVU26D |
| 2026-07-01 | $57.93 | $45.40 | RVU26C |
| 2026-04-01 | $57.93 | $45.40 | RVU26B |
| 2026-01-01 | $57.93 | $45.40 | RVU26A |
| 2025-10-01 | $54.97 | $49.03 | RVU25D |
| 2025-07-01 | $54.97 | $49.03 | RVU25C |
| 2025-04-01 | $54.97 | $49.03 | RVU25B |
| 2025-01-01 | $54.97 | $49.03 | RVU25A |
| 2024-10-01 | $61.72 | $57.51 | RVU24D |
| 2024-07-01 | $61.72 | $57.51 | RVU24C |
| 2024-04-01 | $61.72 | $57.51 | RVU24B |
| 2024-03-09 | $61.72 | $57.51 | RVU24AR |
| 2024-01-01 | $60.71 | $56.58 | RVU24A |
| 2023-10-01 | $62.04 | $57.77 | RVU23D |
| 2023-07-01 | $62.04 | $57.77 | RVU23C |
| 2023-04-01 | $62.04 | $57.77 | RVU23B |
| 2023-01-01 | $62.04 | $57.77 | RVU23A |
| 2022-10-01 | $63.14 | $58.79 | RVU22D |
| 2022-07-01 | $63.14 | $58.79 | RVU22C |
| 2022-04-01 | $63.14 | $58.79 | RVU22B |
| 2022-01-01 | $63.14 | $58.79 | RVU22A |
| 2021-10-01 | $60.80 | $56.02 | RVU21D |
| 2021-07-01 | $60.80 | $56.02 | RVU21C |
| 2021-04-01 | $60.80 | $56.02 | RVU21B |
| 2021-01-01 | $60.80 | $56.02 | RVU21A |
| 2020-10-01 | $64.98 | $61.26 | RVU20D |
| 2020-07-01 | $64.98 | $61.26 | RVU20C |
| 2020-04-01 | $64.98 | $61.26 | RVU20B |
| 2020-01-01 | $64.98 | $61.26 | RVU20A |
| 2019-10-01 | $63.22 | $60.74 | RVU19D |
| 2019-07-01 | $63.22 | $60.74 | RVU19C |
| 2019-04-01 | $63.22 | $60.74 | RVU19B |
| 2019-01-01 | $63.22 | $60.74 | RVU19A |
| 2018-10-01 | Not in this release | Not in this release | RVU18D |
| 2018-07-01 | Not in this release | Not in this release | RVU18C |
| 2018-04-01 | Not in this release | Not in this release | RVU18B |
| 2018-01-01 | Not in this release | Not in this release | RVU18AR1 |
| 2017-10-01 | Not in this release | Not in this release | RVU17D |
| 2017-07-01 | Not in this release | Not in this release | RVU17C |
| 2017-04-01 | Not in this release | Not in this release | RVU17B |
| 2017-01-01 | Not in this release | Not in this release | RVU17A |
| 2016-10-01 | Not in this release | Not in this release | RVU16D |
| 2016-07-01 | Not in this release | Not in this release | RVU16C |
| 2016-04-01 | Not in this release | Not in this release | RVU16B |
| 2016-01-01 | Not in this release | Not in this release | RVU16A |
| 2015-10-01 | Not in this release | Not in this release | RVU15D |
| 2015-07-01 | Not in this release | Not in this release | RVU15C |
| 2015-04-01 | Not in this release | Not in this release | RVU15B |
| 2015-01-01 | Not in this release | Not in this release | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Hawaii, Guam, HI rate applies
Hawaii, Guam, HI is a Medicare payment area, not a city. Our Census mapping connects it to 163 cities and communities in Hawaii. Some span more than one payment area; confirm with the service ZIP.
- Ahuimanu
- Aiea
- Ainaloa
- Anahola
- Black Sands
- Captain Cook
- Discovery Harbour
- East Honolulu
96113 billing questions
How does 96113 differ from 96112?
96112 represents the initial hour of developmental testing. Use 96113 for each additional 30 minutes of qualifying testing time, paired with 96112.
Can 96113 be billed without 96112?
No. It is an add-on code and must be reported with 96112, the primary developmental-testing service.
Is 96113 appropriate for a brief developmental screen?
No. A brief screen with a score is represented by 96110; 96113 is for additional time in a formal developmental test service.
What documentation supports an additional unit?
Document the test activities, developmental functions assessed, total qualifying time, and the resulting scoring, interpretation, and report. The record should support each additional 30-minute unit billed.
Does a modifier allow 96113 to stand alone?
No. A modifier does not replace the required 96112 primary code pairing.
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
Show the CMS file lines behind this rate
Fee sheets · Coming soon
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