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

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 Utah, Medicare pays $92.18 for 96116 in the office and $71.46 when it’s performed in a hospital or facility.

$92.18Office (non-facility)
$71.46Hospital or facility
−2.1%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 Utah
  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 Utah 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. Utah pays $92.18. The RVUs are the same everywhere; the geographic indexes change the dollars.

96116 in Utah vs other payment areas
  1. Utah · this page$92.18
  2. Los Angeles, CA · California$101.57+$9.39
  3. Washington, DC area · District of Columbia$103.12+$10.94
  4. Miami, FL · Florida$98.49+$6.31
  5. Chicago, IL · Illinois$97.37+$5.19
  6. Manhattan, NY · New York$104.21+$12.03
  7. Alaska · Alaska$126.31+$34.13

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

Every other payment area

96116 in every other Medicare payment locality
Payment localityOfficeFacility
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

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 Utah 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

104

Locality
Utah
Physician work
1.000
Practice expense
0.940
Malpractice
0.898
Office calculation for 96116 in Utah
ComponentRVULocality factorAdjusted
Physician work1.86× 1.0001.8600
Practice expense0.90× 0.9400.8460
Malpractice0.06× 0.8980.0539
Total RVUs2.7599
Conversion factor× 33.4009

Office rate, Utah$92.18

Office: (1.86 × 1 + 0.9 × 0.94 + 0.06 × 0.898) × $33.4009 = $92.18

Facility: (1.86 × 1 + 0.24 × 0.94 + 0.06 × 0.898) × $33.4009 = $71.46

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, Utah
Add-on codes
96121Neurobehavioral exam, each additional hourAdd-on code for additional qualifying time after the initial hour.$74.37
Used instead
96132Neuropsychological evaluation, first hourProfessional evaluation associated with neuropsychological testing rather than a neurobehavioral status examination.$119.94
96125Cognitive testing, per qualified professional hourUsed for cognitive performance testing by a health care professional.$100.05
96105Aphasia assessment, per hourFocused assessment of aphasia rather than a broader neurobehavioral examination.$94.80

How 96116 has changed in Utah

96116 · Office / nonfacility

$92.18

Effective 2026-10-01

The base rate is $5.46 higher than on 2025-10-01, moving from $86.72 to $92.18 (6.3%).

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

    $86.72changed to$92.18

    • 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 0.933 changed to 0.940
    • Malpractice GPCI 0.930 changed to 0.898

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $89.86changed to$86.72

    • 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

    $88.39changed to$89.86

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $90.79changed to$88.39

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 0.81 changed to 0.82
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.865 changed to 0.930

  5. January 1, 2023

    RVU23A

    $92.93changed to$90.79

    • 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 0.919 changed to 0.926
    • Malpractice GPCI 0.799 changed to 0.865

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $94.03changed to$92.93

    • 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

    $97.30changed to$94.03

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 0.81 changed to 0.83
    • Practice expense GPCI 0.923 changed to 0.919
    • Malpractice GPCI 0.982 changed to 0.799

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $95.87changed to$97.30

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 0.75 changed to 0.81
    • Practice expense GPCI 0.927 changed to 0.923
    • Malpractice GPCI 1.165 changed to 0.982

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $94.09changed to$95.87

    • 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

    $92.10changed to$94.09

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 0.65 changed to 0.70
    • Practice expense GPCI 0.925 changed to 0.927
    • Malpractice GPCI 1.167 changed to 1.165

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $92.57changed to$92.10

    • 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 0.922 changed to 0.925
    • Malpractice GPCI 1.169 changed to 1.167

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $92.90changed to$92.57

    • Conversion factor 35.9335 changed to 35.8043

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $92.44changed to$92.90

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $93.42changed to$92.44

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 0.69 changed to 0.66
    • Practice expense GPCI 0.919 changed to 0.922
    • Malpractice GPCI 1.136 changed to 1.169

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $87.60changed to$93.42

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 0.66 changed to 0.69
    • Practice expense GPCI 0.916 changed to 0.919
    • Malpractice GPCI 1.102 changed to 1.136

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $87.60

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$92.18$71.46RVU26D
2026-07-01$92.18$71.46RVU26C
2026-04-01$92.18$71.46RVU26B
2026-01-01$92.18$71.46RVU26A
2025-10-01$86.72$75.25RVU25D
2025-07-01$86.72$75.25RVU25C
2025-04-01$86.72$75.25RVU25B
2025-01-01$86.72$75.25RVU25A
2024-10-01$89.86$77.75RVU24D
2024-07-01$89.86$77.75RVU24C
2024-04-01$89.86$77.75RVU24B
2024-03-09$89.86$77.75RVU24AR
2024-01-01$88.39$76.48RVU24A
2023-10-01$90.79$78.87RVU23D
2023-07-01$90.79$78.87RVU23C
2023-04-01$90.79$78.87RVU23B
2023-01-01$90.79$78.87RVU23A
2022-10-01$92.93$80.85RVU22D
2022-07-01$92.93$80.85RVU22C
2022-04-01$92.93$80.85RVU22B
2022-01-01$92.93$80.85RVU22A
2021-10-01$94.03$81.84RVU21D
2021-07-01$94.03$81.84RVU21C
2021-04-01$94.03$81.84RVU21B
2021-01-01$94.03$81.84RVU21A
2020-10-01$97.30$85.31RVU20D
2020-07-01$97.30$85.31RVU20C
2020-04-01$97.30$85.31RVU20B
2020-01-01$97.30$85.31RVU20A
2019-10-01$95.87$86.18RVU19D
2019-07-01$95.87$86.18RVU19C
2019-04-01$95.87$86.18RVU19B
2019-01-01$95.87$86.18RVU19A
2018-10-01$94.09$86.42RVU18D
2018-07-01$94.09$86.42RVU18C
2018-04-01$94.09$86.42RVU18B
2018-01-01$94.09$86.42RVU18AR1
2017-10-01$92.10$86.79RVU17D
2017-07-01$92.10$86.79RVU17C
2017-04-01$92.10$86.79RVU17B
2017-01-01$92.10$86.79RVU17A
2016-10-01$92.57$87.29RVU16D
2016-07-01$92.57$87.29RVU16C
2016-04-01$92.57$87.29RVU16B
2016-01-01$92.57$87.29RVU16A
2015-10-01$92.90$87.27RVU15D
2015-07-01$92.90$87.27RVU15C
2015-04-01$92.44$86.84RVU15B
2015-01-01$92.44$86.84RVU15A
2014-10-01$93.42$87.82RVU14D
2014-07-01$93.42$87.82RVU14C
2014-04-01$93.42$87.82RVU14B
2014-01-01$93.42$87.82RVU14A
2013-10-01$87.60$81.99RVU13D
2013-07-01$87.60$81.99RVU13C
2013-04-01$87.60$81.99RVU13B
2013-01-01$87.60$81.99RVU13AR

Price 96116 for an earlier date of service

Where the Utah rate applies

Utah is a Medicare payment area, not a city. Our Census mapping connects it to 334 cities and communities in Utah. Some span more than one payment area; confirm with the service ZIP.

  • Alpine
  • Alta
  • Altamont
  • Alton
  • Amalga
  • American Fork
  • Aneth
  • Annabella

Browse all communities in Utah

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 UtahGPCI2026.csv, line 104 (RVU26D)

Open CMS sourceHow we calculate rates

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