CPT code 96116: Neurobehavioral exam, first hour2026 Medicare rate & RVUs in Puerto Rico
A physician or qualified health care professional uses this code for a clinical examination of cognitive and behavioral functioning, including interpretation and reporting.
In Puerto Rico, Medicare pays $94.49 for 96116 in the office and $72.20 when it’s performed in a hospital or facility.
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.
On this page 11 sections
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 Puerto Rico 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. Puerto Rico pays $94.49. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$94.49
- Los Angeles, CA · California$101.57+$7.08
- Washington, DC area · District of Columbia$103.12+$8.63
- Miami, FL · Florida$98.49+$4.00
- Chicago, IL · Illinois$97.37+$2.88
- Manhattan, NY · New York$104.21+$9.72
- Alaska · Alaska$126.31+$31.82
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| 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 |
| El Centro, CACalifornia | $97.21 | $73.05 |
| Fresno, CACalifornia | $97.20 | $73.04 |
| Hanford, CACalifornia | $97.20 | $73.04 |
| Madera, CACalifornia | $97.20 | $73.04 |
| Merced, CACalifornia | $97.20 | $73.04 |
| Modesto, CACalifornia | $97.20 | $73.04 |
| Napa, CACalifornia | $106.68 | $77.62 |
| Oxnard, CACalifornia | $100.65 | $74.59 |
| Redding, CACalifornia | $97.20 | $73.04 |
| Rest of CaliforniaCalifornia | $97.20 | $73.04 |
| Riverside, CACalifornia | $97.90 | $73.74 |
| Sacramento, CACalifornia | $100.40 | $74.76 |
| Salinas, CACalifornia | $99.97 | $74.42 |
| San Diego, CACalifornia | $101.03 | $74.66 |
| Marin County, CACalifornia | $111.33 | $80.25 |
| San Francisco, CACalifornia | $111.27 | $80.18 |
| San Benito County, CACalifornia | $113.38 | $81.59 |
| Santa Clara County, CACalifornia | $113.10 | $81.31 |
| San Luis Obispo, CACalifornia | $98.50 | $73.39 |
| Santa Cruz, CACalifornia | $101.03 | $74.24 |
| Santa Maria, CACalifornia | $99.99 | $74.29 |
| Santa Rosa, CACalifornia | $101.98 | $74.91 |
| Stockton, CACalifornia | $97.20 | $73.04 |
| Vallejo, CACalifornia | $106.58 | $77.52 |
| Visalia, CACalifornia | $97.20 | $73.04 |
| Yuba City, CACalifornia | $97.20 | $73.04 |
| ColoradoColorado | $96.42 | $72.97 |
| ConnecticutConnecticut | $98.17 | $74.43 |
| DelawareDelaware | $93.94 | $72.16 |
| Fort Lauderdale, FLFlorida | $96.20 | $73.87 |
| Rest of FloridaFlorida | $93.88 | $72.80 |
| Atlanta, GAGeorgia | $95.26 | $72.86 |
| Rest of GeorgiaGeorgia | $91.33 | $71.66 |
| Hawaii, Guam, HIHawaii | $97.47 | $72.40 |
| IowaIowa | $90.43 | $70.26 |
| IdahoIdaho | $90.73 | $70.45 |
| East St. Louis, ILIllinois | $93.82 | $73.54 |
| Rest of IllinoisIllinois | $92.70 | $72.58 |
| Suburban Chicago, ILIllinois | $96.98 | $74.34 |
| IndianaIndiana | $90.97 | $70.53 |
| KansasKansas | $90.31 | $70.38 |
| KentuckyKentucky | $90.68 | $71.09 |
| New Orleans, LALouisiana | $92.69 | $71.95 |
| Rest of LouisianaLouisiana | $90.65 | $71.14 |
| Metropolitan Boston, MAMassachusetts | $102.35 | $76.03 |
| Rest of MassachusettsMassachusetts | $96.37 | $73.16 |
| Baltimore area, MDMaryland | $97.85 | $74.20 |
| Rest of MarylandMaryland | $95.01 | $72.70 |
| Rest of MaineMaine | $91.03 | $70.75 |
| Southern Maine, MEMaine | $93.18 | $71.33 |
| Detroit, MIMichigan | $94.51 | $73.24 |
| Rest of MichiganMichigan | $91.83 | $71.71 |
| MinnesotaMinnesota | $93.65 | $70.97 |
| Metropolitan Kansas City, MOMissouri | $92.31 | $71.61 |
| Metropolitan St. Louis, MOMissouri | $92.75 | $71.77 |
| Rest of MissouriMissouri | $89.99 | $70.99 |
| MississippiMississippi | $89.49 | $70.51 |
| MontanaMontana | $94.19 | $72.14 |
| North CarolinaNorth Carolina | $91.45 | $70.89 |
| North DakotaNorth Dakota | $93.00 | $70.96 |
| NebraskaNebraska | $90.63 | $70.28 |
| New HampshireNew Hampshire | $95.17 | $72.22 |
| Northern New JerseyNew Jersey | $103.05 | $77.48 |
| Rest of New JerseyNew Jersey | $99.64 | $75.56 |
| New MexicoNew Mexico | $92.10 | $71.88 |
| NevadaNevada | $93.89 | $71.82 |
| NYC suburbs and Long Island, NYNew York | $105.57 | $79.35 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $100.26 | $76.12 |
| Queens, NYNew York | $104.52 | $78.47 |
| Rest of New YorkNew York | $92.09 | $71.15 |
| OhioOhio | $91.59 | $71.46 |
| OklahomaOklahoma | $90.53 | $70.84 |
| Portland, OROregon | $98.01 | $73.52 |
| Rest of OregonOregon | $93.48 | $71.52 |
| Metropolitan Philadelphia, PAPennsylvania | $96.93 | $73.98 |
| Rest of PennsylvaniaPennsylvania | $91.62 | $71.38 |
| Rhode IslandRhode Island | $96.15 | $73.37 |
| South CarolinaSouth Carolina | $91.61 | $71.24 |
| South DakotaSouth Dakota | $92.86 | $70.82 |
| TennesseeTennessee | $90.53 | $70.49 |
| Austin, TXTexas | $95.83 | $72.51 |
| Beaumont, TXTexas | $91.34 | $71.28 |
| Brazoria, TXTexas | $93.98 | $72.13 |
| Dallas, TXTexas | $94.34 | $72.39 |
| Fort Worth, TXTexas | $94.07 | $72.33 |
| Galveston, TXTexas | $94.13 | $72.24 |
| Houston, TXTexas | $95.23 | $73.34 |
| Rest of TexasTexas | $92.46 | $71.54 |
| UtahUtah | $92.18 | $71.46 |
| VirginiaVirginia | $93.09 | $71.42 |
| Virgin Islands, VIUnited States Virgin Islands | $94.49 | $72.20 |
| VermontVermont | $92.90 | $71.08 |
| Rest of WashingtonWashington | $96.11 | $72.90 |
| King County, WAWashington | $103.75 | $76.71 |
| WisconsinWisconsin | $91.54 | $70.42 |
| West VirginiaWest Virginia | $91.12 | $71.96 |
| WyomingWyoming | $93.67 | $71.62 |
96116 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.
$88.98
$126.31
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 | $126.31 | 1 |
| AL | $89.56 | 1 |
| AR | $88.98 | 1 |
| AZ | $92.97 | 1 |
| CA | $97.20–$113.38 | 29 |
| CO | $96.42 | 1 |
| CT | $98.17 | 1 |
| DC | $103.12 | 1 |
| DE | $93.94 | 1 |
| FL | $93.88–$98.49 | 3 |
| GA | $91.33–$95.26 | 2 |
| GU | $97.47 | 1 |
| HI | $97.47 | 1 |
| IA | $90.43 | 1 |
| ID | $90.73 | 1 |
| IL | $92.70–$97.37 | 4 |
| IN | $90.97 | 1 |
| KS | $90.31 | 1 |
| KY | $90.68 | 1 |
| LA | $90.65–$92.69 | 2 |
| MA | $96.37–$102.35 | 2 |
| MD | $95.01–$103.12 | 3 |
| ME | $91.03–$93.18 | 2 |
| MI | $91.83–$94.51 | 2 |
| MN | $93.65 | 1 |
| MO | $89.99–$92.75 | 3 |
| MS | $89.49 | 1 |
| MT | $94.19 | 1 |
| NC | $91.45 | 1 |
| ND | $93.00 | 1 |
| NE | $90.63 | 1 |
| NH | $95.17 | 1 |
| NJ | $99.64–$103.05 | 2 |
| NM | $92.10 | 1 |
| NV | $93.89 | 1 |
| NY | $92.09–$105.57 | 5 |
| OH | $91.59 | 1 |
| OK | $90.53 | 1 |
| OR | $93.48–$98.01 | 2 |
| PA | $91.62–$96.93 | 2 |
| PR | $94.49 | 1 |
| RI | $96.15 | 1 |
| SC | $91.61 | 1 |
| SD | $92.86 | 1 |
| TN | $90.53 | 1 |
| TX | $91.34–$95.83 | 8 |
| UT | $92.18 | 1 |
| VA | $93.09–$103.12 | 2 |
| VI | $94.49 | 1 |
| VT | $92.90 | 1 |
| WA | $96.11–$103.75 | 2 |
| WI | $91.54 | 1 |
| WV | $91.12 | 1 |
| WY | $93.67 | 1 |
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
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 Puerto Rico 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
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.86 | × 1.000 | 1.8600 |
| Practice expense | 0.90 | × 1.011 | 0.9099 |
| Malpractice | 0.06 | × 0.985 | 0.0591 |
| Total RVUs | 2.8290 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Puerto Rico$94.49
Office: (1.86 × 1 + 0.9 × 1.011 + 0.06 × 0.985) × $33.4009 = $94.49
Facility: (1.86 × 1 + 0.24 × 1.011 + 0.06 × 0.985) × $33.4009 = $72.20
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.
How 96116 has changed in Puerto Rico
96116 · Office / nonfacility
$94.49
Effective 2026-10-01
The base rate is $5.72 higher than on 2025-10-01, moving from $88.77 to $94.49 (6.4%).
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
$88.77changed to$94.49
- 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
- Practice expense GPCI 1.007 changed to 1.011
- Malpractice GPCI 0.982 changed to 0.985
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$92.02changed to$88.77
- 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.
March 9, 2024
RVU24AR
$90.51changed to$92.02
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$93.37changed to$90.51
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 0.81 changed to 0.82
- Practice expense GPCI 1.008 changed to 1.007
- Malpractice GPCI 0.984 changed to 0.982
October 1, 2023
RVU23D
$93.19changed to$93.37
- Practice expense GPCI 1.000 changed to 1.008
- Malpractice GPCI 1.000 changed to 0.984
January 1, 2023
RVU23A
$96.04changed to$93.19
- 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
- Practice expense GPCI 1.008 changed to 1.000
- Malpractice GPCI 0.986 changed to 1.000
Held through RVU23B, RVU23C.
January 1, 2022
RVU22A
$97.19changed to$96.04
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 0.83 changed to 0.82
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$99.80changed to$97.19
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 0.81 changed to 0.83
- Malpractice GPCI 0.988 changed to 0.986
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$97.46changed to$99.80
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 0.75 changed to 0.81
- Practice expense GPCI 1.007 changed to 1.008
- Malpractice GPCI 0.990 changed to 0.988
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$95.54changed to$97.46
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 0.70 changed to 0.75
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$88.80changed to$95.54
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 0.65 changed to 0.70
- Practice expense GPCI 0.856 changed to 1.007
- Malpractice GPCI 0.642 changed to 0.990
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$84.30changed to$88.80
- 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 0.705 changed to 0.856
- Malpractice GPCI 0.293 changed to 0.642
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$84.61changed to$84.30
- Conversion factor 35.9335 changed to 35.8043
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$84.19changed to$84.61
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$84.71changed to$84.19
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 0.69 changed to 0.66
- Practice expense GPCI 0.692 changed to 0.705
- Malpractice GPCI 0.271 changed to 0.293
Held through RVU15B.
January 1, 2014
RVU14A
$79.35changed to$84.71
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 0.66 changed to 0.69
- Practice expense GPCI 0.678 changed to 0.692
- Malpractice GPCI 0.249 changed to 0.271
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $79.35
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $94.49 | $72.20 | RVU26D |
| 2026-07-01 | $94.49 | $72.20 | RVU26C |
| 2026-04-01 | $94.49 | $72.20 | RVU26B |
| 2026-01-01 | $94.49 | $72.20 | RVU26A |
| 2025-10-01 | $88.77 | $76.39 | RVU25D |
| 2025-07-01 | $88.77 | $76.39 | RVU25C |
| 2025-04-01 | $88.77 | $76.39 | RVU25B |
| 2025-01-01 | $88.77 | $76.39 | RVU25A |
| 2024-10-01 | $92.02 | $78.94 | RVU24D |
| 2024-07-01 | $92.02 | $78.94 | RVU24C |
| 2024-04-01 | $92.02 | $78.94 | RVU24B |
| 2024-03-09 | $92.02 | $78.94 | RVU24AR |
| 2024-01-01 | $90.51 | $77.66 | RVU24A |
| 2023-10-01 | $93.37 | $80.39 | RVU23D |
| 2023-07-01 | $93.19 | $80.31 | RVU23C |
| 2023-04-01 | $93.19 | $80.31 | RVU23B |
| 2023-01-01 | $93.19 | $80.31 | RVU23A |
| 2022-10-01 | $96.04 | $82.79 | RVU22D |
| 2022-07-01 | $96.04 | $82.79 | RVU22C |
| 2022-04-01 | $96.04 | $82.79 | RVU22B |
| 2022-01-01 | $96.04 | $82.79 | RVU22A |
| 2021-10-01 | $97.19 | $83.83 | RVU21D |
| 2021-07-01 | $97.19 | $83.83 | RVU21C |
| 2021-04-01 | $97.19 | $83.83 | RVU21B |
| 2021-01-01 | $97.19 | $83.83 | RVU21A |
| 2020-10-01 | $99.80 | $86.71 | RVU20D |
| 2020-07-01 | $99.80 | $86.71 | RVU20C |
| 2020-04-01 | $99.80 | $86.71 | RVU20B |
| 2020-01-01 | $99.80 | $86.71 | RVU20A |
| 2019-10-01 | $97.46 | $86.94 | RVU19D |
| 2019-07-01 | $97.46 | $86.94 | RVU19C |
| 2019-04-01 | $97.46 | $86.94 | RVU19B |
| 2019-01-01 | $97.46 | $86.94 | RVU19A |
| 2018-10-01 | $95.54 | $87.21 | RVU18D |
| 2018-07-01 | $95.54 | $87.21 | RVU18C |
| 2018-04-01 | $95.54 | $87.21 | RVU18B |
| 2018-01-01 | $95.54 | $87.21 | RVU18AR1 |
| 2017-10-01 | $88.80 | $83.88 | RVU17D |
| 2017-07-01 | $88.80 | $83.88 | RVU17C |
| 2017-04-01 | $88.80 | $83.88 | RVU17B |
| 2017-01-01 | $88.80 | $83.88 | RVU17A |
| 2016-10-01 | $84.30 | $80.27 | RVU16D |
| 2016-07-01 | $84.30 | $80.27 | RVU16C |
| 2016-04-01 | $84.30 | $80.27 | RVU16B |
| 2016-01-01 | $84.30 | $80.27 | RVU16A |
| 2015-10-01 | $84.61 | $80.30 | RVU15D |
| 2015-07-01 | $84.61 | $80.30 | RVU15C |
| 2015-04-01 | $84.19 | $79.90 | RVU15B |
| 2015-01-01 | $84.19 | $79.90 | RVU15A |
| 2014-10-01 | $84.71 | $80.49 | RVU14D |
| 2014-07-01 | $84.71 | $80.49 | RVU14C |
| 2014-04-01 | $84.71 | $80.49 | RVU14B |
| 2014-01-01 | $84.71 | $80.49 | RVU14A |
| 2013-10-01 | $79.35 | $75.20 | RVU13D |
| 2013-07-01 | $79.35 | $75.20 | RVU13C |
| 2013-04-01 | $79.35 | $75.20 | RVU13B |
| 2013-01-01 | $79.35 | $75.20 | RVU13AR |
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
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
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