Billing code 96112: Developmental testingMedicare rate & RVUs

Medicare pays $125.25 for 96112 nationally in the office and $106.88 in a hospital or facility. Local office rates run $118.04–$168.19.

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

What 96112 covers

A physician or other qualified health care professional uses standardized developmental measures and clinical observation to assess areas such as motor skills, language, cognition, social functioning, memory, or executive function. The service is commonly performed in a pediatric, developmental, psychology, or rehabilitation setting when a child’s development needs a more complete evaluation than a brief screening can provide. The clinician interprets the results and prepares a report.

Report 96112 for the initial hour of qualifying developmental testing. Documentation should identify the assessment performed, the developmental domains evaluated, the clinician’s work, and the interpretation and report. When additional qualifying testing time is supported, report it with 96113, the add-on code for additional time. Medicare physician fee schedule valuation is available by setting; the submitted service and setting determine the applicable schedule amount.

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 96112 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

96112 rates by state

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

How the 96112 rate is calculated

Each of 96112’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.

Payment rules and modifiers for 96112

96112 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.

96112 compared with similar codes

How to choose

96110Developmental screen w/score

Choose 96110 for developmental screening with a score. Choose 96112 when a physician or qualified health care professional performs a fuller developmental testing service with interpretation and a report.

96113Developmental testing

96112 represents the initial hour of developmental testing. 96113 is used for additional qualifying time and is reported as an add-on.

96116Neurobehavioral exam

96116 is for a neurobehavioral status examination. 96112 is for developmental testing focused on developmental domains assessed with appropriate measures.

96130Psychological evaluation

96130 covers psychological test evaluation. Use 96112 when the service is developmental testing, rather than psychological test evaluation.

Codes related to 96112

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

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

Open CMS sourceHow we calculate rates