CPT code 96125: Cognitive testing, per qualified professional hour2026 Medicare rate & RVUs in Florida
Report standardized cognitive performance testing when a qualified health professional administers tests, interprets results, and prepares a clinical report.
Medicare pays $101.58–$106.75 for 96125 in the office in Florida, from Rest of Florida to Miami, FL. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 96125 covers
This service covers standardized testing of cognitive performance, such as attention, memory, problem solving, or executive function. A speech-language pathologist may use it to assess cognitive-communication deficits after a stroke or traumatic brain injury; other qualified health professionals may assess cognitive concerns in rehabilitation or similar clinical settings. The work includes administering tests to the patient, interpreting the results, and preparing a report.
Report the code by the qualified professional’s total time for those testing activities, supported by documentation of the clinical reason, tests administered, findings, interpretation, and report. It is a therapy service, so a professional-component modifier does not apply. Under the CMS therapy multiple procedure payment reduction, the practice expense portion is reduced when this is the second or a later therapy unit on the same day.
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.
Where 96125 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$101.58 to $106.75
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale, FL | $104.54 | Unavailable |
| Miami, FL | $106.75 | Unavailable |
| Rest of Florida | $101.58 | Unavailable |
How the 96125 rate is calculated
Each of 96125’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 · 96125
RVUs × geographic indexes × conversion factor
Work1.70
1.70 RVUs× 1.000 GPCI
Practice expense1.34
1.34 RVUs× 1.000 GPCI
Malpractice0.04
0.04 RVUs× 1.000 GPCI
Adjusted RVUs
3.0800
Conversion factor
$33.4009
Medicare rate
$102.87
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 96125
The CMS indicators that decide how 96125 is paid alongside other services.
CMS payment indicators · 96125
Cognitive testing, per qualified professional hour
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 5 | Therapy reduction: practice expense of the second and later units is reduced. |
| 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 | 7 | Therapy service: the split doesn’t apply. |
What modifiers do to the payment
Modifier CQ · payment effect
With and without the modifier
96125 without CQ · national office
$102.87
Cognitive testing, per qualified professional hour
96125-CQ · Allowed amount unchanged
$102.87
Medicare cuts its own payment by 15% after the patient’s 20% coinsurance; the allowed amount stays the same. On $100 allowed: $20 coinsurance, then Medicare pays $68 instead of $80.
96125 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 96105Aphasia assessmentPer hour
- 96105 addresses aphasia assessment. Choose 96125 when the service is standardized testing of cognitive performance rather than an assessment focused on aphasia.
- 96116Neurobehavioral examFirst hour
- 96116 describes a neurobehavioral status examination. 96125 is used for standardized cognitive performance testing, including test administration and interpretation.
- 96132Neuropsychological evaluationFirst hour
- 96132 covers neuropsychological testing evaluation. Use 96125 for the distinct therapy service of standardized cognitive performance testing.
- 96136Test administrationPhysician or QHP, first 30 minutes
- 96136 is for psychological or neuropsychological test administration and scoring by a qualified professional. 96125 describes standardized cognitive performance testing by the hour, including interpretation and report preparation.
96125 billing questions
When should I use this instead of 96105?
Use 96125 for standardized cognitive performance testing. Code 96105 is for assessment focused on aphasia.
Does 96125 include interpreting the results and preparing the report?
Yes. Those activities are part of the service, along with administering the tests to the patient; do not separately report them as components of the same testing service.
Do I append modifier 26?
No. CMS identifies 96125 as a therapy service for which the professional-component modifier does not apply.
How do I support the number of units?
The code is reported per qualified professional hour. Document the time spent administering tests, interpreting results, and preparing the report.
How does the therapy multiple procedure reduction affect this code?
When 96125 is the second or a later therapy unit on the same day, CMS reduces its practice expense portion.
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
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