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Billing code 96125: Cognitive testingMedicare rate & RVUs

Report standardized cognitive performance testing when a qualified health professional administers tests, interprets results, and prepares a clinical report.

CMS RVU26DEffective Oct 1, 2026109 payment localities11.2K Medicare services in 2024

Medicare pays $102.87 for 96125 nationally in the office. Local office rates run $95.92–$133.57.

Medicare rate · 96125

Cognitive testing

Work RVUs
1.7
Total RVUs
3.08
Global days
XXX

National rate · 2026

$102.87

Office setting, before claim adjustments.

See every locality for 96125 →Billed by an NP, PA or therapist? →

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 10 sections
  1. Medicare rate
  2. What 96125 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

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

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

109 payment localities

$95.92 to $133.57

$95.92$114.75$133.57
One dot per payment locality, office / nonfacility. Hover a dot to see the locality; select it to open that rate.

109 of 109 payment localities

96125 office and facility rates by payment locality
Payment localityOfficeFacility
Alabama$96.70Unavailable
Alaska*$133.57Unavailable
Arizona$101.29Unavailable
Arkansas$95.92Unavailable
Atlanta$104.03Unavailable
Austin$105.43Unavailable
Bakersfield$107.73Unavailable
Baltimore/Surr. Cntys$107.37Unavailable
Beaumont$98.75Unavailable
Brazoria$102.63Unavailable

96125 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.

$95.92

$133.57

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

View every state and territory as a table
96125 office rate range by state
State / territoryOffice rate rangeLocalities
AK$133.571
AL$96.701
AR$95.921
AZ$101.291
CA$107.52–$128.2829
CO$106.131
CT$107.741
DC$114.061
DE$102.491
FL$101.58–$106.753
GA$98.30–$104.032
GU$108.441
HI$108.441
IA$98.261
ID$98.591
IL$99.73–$105.514
IN$98.921
KS$97.921
KY$97.791
LA$97.67–$100.422
MA$105.88–$113.742
MD$103.87–$114.063
ME$98.79–$101.982
MI$99.15–$102.222
MN$103.231
MO$96.66–$100.733
MS$96.301
MT$102.871
NC$99.391
ND$102.081
NE$98.601
NH$104.541
NJ$109.39–$113.702
NM$99.431
NV$102.701
NY$100.24–$116.115
OH$98.991
OK$97.791
OR$102.30–$108.412
PA$99.13–$105.992
PR$103.351
RI$105.291
SC$99.271
SD$101.991
TN$98.181
TX$98.75–$105.438
UT$100.051
VA$101.72–$114.062
VI$103.351
VT$101.771
WA$105.67–$115.632
WI$100.071
WV$97.591
WY$102.531

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

RuleCMS valueWhat it means
Global periodXXXThe global surgery concept doesn’t apply.
Multiple procedures5Therapy reduction: practice expense of the second and later units is reduced.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical7Therapy 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

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

  • 96125

    Cognitive testing1.7 wRVU

    $102.87

  • 96105

    Aphasia assessment1.75 wRVU

    $97.20−$5.67

  • 96116

    Neurobehavioral exam1.86 wRVU

    $94.19−$8.68

  • 96132

    Neuropsychological evaluation2.56 wRVU

    $122.25+$19.38

  • 96136

    Test administration0.55 wRVU

    $43.76−$59.11

How to choose

96105Aphasia assessment
96105 addresses aphasia assessment. Choose 96125 when the service is standardized testing of cognitive performance rather than an assessment focused on aphasia.
96116Neurobehavioral exam
96116 describes a neurobehavioral status examination. 96125 is used for standardized cognitive performance testing, including test administration and interpretation.
96132Neuropsychological evaluation
96132 covers neuropsychological testing evaluation. Use 96125 for the distinct therapy service of standardized cognitive performance testing.
96136Test administration
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.

Codes related to 96125

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

Codes related to 96125
CodeHow it relatesNational office range
Used instead
96105Aphasia assessmentUsed for assessment focused on aphasia rather than broader cognitive performance testing.$91.16–$128.08
96116Neurobehavioral examA neurobehavioral status examination is distinct from standardized cognitive performance testing.$88.98–$126.31
96132Neuropsychological evaluationNeuropsychological testing evaluation is a different service from cognitive performance testing.$116.26–$166.19
96136Test administrationFor psychological or neuropsychological test administration and scoring by a qualified professional.$39.95–$56.39

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

Show the CMS file lines behind this rate
RVUs for 96125PPRRVU2026_Oct_nonQPP.csv, line 12,753 (RVU26D)

Open CMS sourceHow we calculate rates

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