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CPT code 96116: Neurobehavioral exam, first hour2026 Medicare rate & RVUs in Queens, NY

A physician or qualified health care professional uses this code for a clinical examination of cognitive and behavioral functioning, including interpretation and reporting.

CMS RVU26DEffective Oct 1, 2026One payment locality136.5K Medicare services in 2024

In Queens, NY, Medicare pays $104.52 for 96116 in the office and $78.47 when it’s performed in a hospital or facility.

$104.52Office (non-facility)
$78.47Hospital or facility
+11.0%vs the national office rate ($94.19)

Check a contract rate as a % of Medicare · 96116 nationwide

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

We’ll open 96116 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Queens, NY
  2. What 96116 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 96116 covers

A physician or other qualified health care professional performs a clinical assessment of thinking, reasoning, judgment, and related abilities such as attention, language, memory, planning, and problem solving. The examination may help characterize cognitive or behavioral changes associated with conditions such as traumatic brain injury, stroke, dementia, or other neurologic disease. It is a clinician-led assessment, not simply the administration of a standardized test by support staff.

Report 96116 for the initial hour of the service, including face-to-face assessment and the clinician’s time interpreting findings and preparing the report. Documentation should identify the cognitive or behavioral concerns examined, relevant findings, clinical interpretation, and time spent. For additional qualifying time, 96121 is the related add-on code. CMS values the service under the physician fee schedule, with practice-expense values that differ between office and facility settings.

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 Queens, NY compares for 96116

Across 109 of 109 payment localities, the office rate for 96116 runs from $88.98 in Arkansas to $126.31 in Alaska. Queens, NY pays $104.52. The RVUs are the same everywhere; the geographic indexes change the dollars.

96116 in Queens, NY vs other payment areas
  1. Queens, NY · this page$104.52
  2. Manhattan, NY · New York$104.21−$0.31
  3. NYC suburbs and Long Island, NY · New York$105.57+$1.05
  4. Poughkeepsie and northern NYC suburbs, NY · New York$100.26−$4.26
  5. Rest of New York · New York$92.09−$12.43
  6. Los Angeles, CA · California$101.57−$2.95
  7. Washington, DC area · District of Columbia$103.12−$1.40

Other areas in New York first, then benchmark localities. Bars start at $0.

Every other payment area

96116 in every other Medicare payment locality
Payment localityOfficeFacility
Miami, FLFlorida$98.49$75.54
Chicago, ILIllinois$97.37$75.22
AlaskaAlaska$126.31$102.83
AlabamaAlabama$89.56$70.27
ArkansasArkansas$88.98$70.04
ArizonaArizona$92.97$71.61
Bakersfield, CACalifornia$97.47$73.31
Chico, CACalifornia$97.20$73.04

96116 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$88.98

$126.31

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
96116 office rate range by state
State / territoryOffice rate rangeLocalities
AK$126.311
AL$89.561
AR$88.981
AZ$92.971
CA$97.20–$113.3829
CO$96.421
CT$98.171
DC$103.121
DE$93.941
FL$93.88–$98.493
GA$91.33–$95.262
GU$97.471
HI$97.471
IA$90.431
ID$90.731
IL$92.70–$97.374
IN$90.971
KS$90.311
KY$90.681
LA$90.65–$92.692
MA$96.37–$102.352
MD$95.01–$103.123
ME$91.03–$93.182
MI$91.83–$94.512
MN$93.651
MO$89.99–$92.753
MS$89.491
MT$94.191
NC$91.451
ND$93.001
NE$90.631
NH$95.171
NJ$99.64–$103.052
NM$92.101
NV$93.891
NY$92.09–$105.575
OH$91.591
OK$90.531
OR$93.48–$98.012
PA$91.62–$96.932
PR$94.491
RI$96.151
SC$91.611
SD$92.861
TN$90.531
TX$91.34–$95.838
UT$92.181
VA$93.09–$103.122
VI$94.491
VT$92.901
WA$96.11–$103.752
WI$91.541
WV$91.121
WY$93.671

See 96116 in every payment locality

How the 96116 rate is calculated

Each of 96116’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 · 96116

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.86

1.86 RVUs× 1.000 GPCI

Practice expense0.90

0.90 RVUs× 1.000 GPCI

Malpractice0.06

0.06 RVUs× 1.000 GPCI

Adjusted RVUs

2.8200

Conversion factor

$33.4009

Medicare rate

$94.19

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Queens, NY inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

12,751

Code
96116
Physician work
1.86
Practice expense
0.90
Malpractice
0.06

GPCI2026.csv

81

Locality
Queens, NY
Physician work
1.064
Practice expense
1.182
Malpractice
1.442
Office calculation for 96116 in Queens, NY
ComponentRVULocality factorAdjusted
Physician work1.86× 1.0641.9790
Practice expense0.90× 1.1821.0638
Malpractice0.06× 1.4420.0865
Total RVUs3.1294
Conversion factor× 33.4009

Office rate, Queens, NY$104.52

Office: (1.86 × 1.064 + 0.9 × 1.182 + 0.06 × 1.442) × $33.4009 = $104.52

Facility: (1.86 × 1.064 + 0.24 × 1.182 + 0.06 × 1.442) × $33.4009 = $78.47

Open 96116 in the RVU calculator

Payment rules and modifiers for 96116

96116 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.

Place of service · 96116

Which rate does Medicare pay?

The POS code on the claim line (CMS-1500 box 24B).

POS 11 · non-facility rate · national

$94.19

Non-facility (office)
$94.19
Facility
$72.15

Higher because the practice carries its own overhead.

Codes related to 96116

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

Codes related to 96116
CodeHow it relatesOffice range, Queens, NY
Add-on codes
96121Neurobehavioral exam, each additional hourAdd-on code for additional qualifying time after the initial hour.$82.57
Used instead
96132Neuropsychological evaluation, first hourProfessional evaluation associated with neuropsychological testing rather than a neurobehavioral status examination.$135.01
96125Cognitive testing, per qualified professional hourUsed for cognitive performance testing by a health care professional.$115.25
96105Aphasia assessment, per hourFocused assessment of aphasia rather than a broader neurobehavioral examination.$108.42

How 96116 has changed in Queens, NY

96116 · Office / nonfacility

$104.52

Effective 2026-10-01

The base rate is $5.82 higher than on 2025-10-01, moving from $98.70 to $104.52 (5.9%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

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

  1. January 1, 2026

    RVU26A

    $98.70changed to$104.52

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 0.81 changed to 0.90
    • Malpractice RVU 0.07 changed to 0.06
    • Work GPCI 1.065 changed to 1.064
    • Practice expense GPCI 1.195 changed to 1.182
    • Malpractice GPCI 1.462 changed to 1.442

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $102.45changed to$98.70

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 0.82 changed to 0.81
    • Malpractice RVU 0.08 changed to 0.07

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $100.78changed to$102.45

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $105.73changed to$100.78

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 0.81 changed to 0.82
    • Work GPCI 1.061 changed to 1.065
    • Practice expense GPCI 1.212 changed to 1.195
    • Malpractice GPCI 2.061 changed to 1.462

  5. January 1, 2023

    RVU23A

    $111.11changed to$105.73

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 0.82 changed to 0.81
    • Malpractice RVU 0.09 changed to 0.08
    • Work GPCI 1.056 changed to 1.061
    • Practice expense GPCI 1.228 changed to 1.212
    • Malpractice GPCI 2.661 changed to 2.061

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $112.46changed to$111.11

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 0.83 changed to 0.82

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $114.01changed to$112.46

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 0.81 changed to 0.83
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.214 changed to 1.228
    • Malpractice GPCI 2.391 changed to 2.661

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $109.83changed to$114.01

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 0.75 changed to 0.81
    • Work GPCI 1.052 changed to 1.054
    • Practice expense GPCI 1.200 changed to 1.214
    • Malpractice GPCI 2.121 changed to 2.391

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $107.55changed to$109.83

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 0.70 changed to 0.75

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $105.17changed to$107.55

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 0.65 changed to 0.70
    • Malpractice GPCI 2.151 changed to 2.121

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $106.20changed to$105.17

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 0.66 changed to 0.65
    • Malpractice RVU 0.10 changed to 0.09
    • Practice expense GPCI 1.199 changed to 1.200
    • Malpractice GPCI 2.181 changed to 2.151

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $106.58changed to$106.20

    • Conversion factor 35.9335 changed to 35.8043

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $106.05changed to$106.58

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $106.59changed to$106.05

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 0.69 changed to 0.66
    • Work GPCI 1.057 changed to 1.052
    • Practice expense GPCI 1.197 changed to 1.199
    • Malpractice GPCI 1.836 changed to 2.181

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $99.11changed to$106.59

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 0.66 changed to 0.69
    • Work GPCI 1.062 changed to 1.057
    • Practice expense GPCI 1.195 changed to 1.197
    • Malpractice GPCI 1.491 changed to 1.836

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $99.11

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$104.52$78.47RVU26D
2026-07-01$104.52$78.47RVU26C
2026-04-01$104.52$78.47RVU26B
2026-01-01$104.52$78.47RVU26A
2025-10-01$98.70$84.01RVU25D
2025-07-01$98.70$84.01RVU25C
2025-04-01$98.70$84.01RVU25B
2025-01-01$98.70$84.01RVU25A
2024-10-01$102.45$86.94RVU24D
2024-07-01$102.45$86.94RVU24C
2024-04-01$102.45$86.94RVU24B
2024-03-09$102.45$86.94RVU24AR
2024-01-01$100.78$85.52RVU24A
2023-10-01$105.73$90.12RVU23D
2023-07-01$105.73$90.12RVU23C
2023-04-01$105.73$90.12RVU23B
2023-01-01$105.73$90.12RVU23A
2022-10-01$111.11$94.96RVU22D
2022-07-01$111.11$94.96RVU22C
2022-04-01$111.11$94.96RVU22B
2022-01-01$111.11$94.96RVU22A
2021-10-01$112.46$96.17RVU21D
2021-07-01$112.46$96.17RVU21C
2021-04-01$112.46$96.17RVU21B
2021-01-01$112.46$96.17RVU21A
2020-10-01$114.01$98.23RVU20D
2020-07-01$114.01$98.23RVU20C
2020-04-01$114.01$98.23RVU20B
2020-01-01$114.01$98.23RVU20A
2019-10-01$109.83$97.29RVU19D
2019-07-01$109.83$97.29RVU19C
2019-04-01$109.83$97.29RVU19B
2019-01-01$109.83$97.29RVU19A
2018-10-01$107.55$97.62RVU18D
2018-07-01$107.55$97.62RVU18C
2018-04-01$107.55$97.62RVU18B
2018-01-01$107.55$97.62RVU18AR1
2017-10-01$105.17$98.27RVU17D
2017-07-01$105.17$98.27RVU17C
2017-04-01$105.17$98.27RVU17B
2017-01-01$105.17$98.27RVU17A
2016-10-01$106.20$99.33RVU16D
2016-07-01$106.20$99.33RVU16C
2016-04-01$106.20$99.33RVU16B
2016-01-01$106.20$99.33RVU16A
2015-10-01$106.58$99.26RVU15D
2015-07-01$106.58$99.26RVU15C
2015-04-01$106.05$98.77RVU15B
2015-01-01$106.05$98.77RVU15A
2014-10-01$106.59$99.30RVU14D
2014-07-01$106.59$99.30RVU14C
2014-04-01$106.59$99.30RVU14B
2014-01-01$106.59$99.30RVU14A
2013-10-01$99.11$91.79RVU13D
2013-07-01$99.11$91.79RVU13C
2013-04-01$99.11$91.79RVU13B
2013-01-01$99.11$91.79RVU13AR

Price 96116 for an earlier date of service

Where the Queens, NY rate applies

Queens, NY is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in New York. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in New York

96116 billing questions

When should 96116 be chosen instead of 96132?

Use 96116 for a clinician’s neurobehavioral status examination of cognitive and behavioral functioning. Code 96132 describes professional evaluation work associated with neuropsychological testing.

How is additional time reported?

96116 represents the initial hour. Code 96121 is the add-on for additional qualifying time, supported by the service documentation.

Does 96116 describe standardized cognitive testing?

No. It describes a clinical assessment and the clinician’s interpretation and report; standardized cognitive performance testing is represented by a different service, such as 96125.

What should the record include?

Document the cognitive or behavioral domains examined, relevant findings, the clinician’s interpretation, the resulting report, and time spent on the service.

How does 96116 differ from an aphasia assessment?

96116 covers a broader neurobehavioral examination. Code 96105 is focused on assessment of aphasia.

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
RVUs for 96116PPRRVU2026_Oct_nonQPP.csv, line 12,751 (RVU26D)
Geographic factors for Queens, NYGPCI2026.csv, line 81 (RVU26D)

Open CMS sourceHow we calculate rates

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