$99.91
96105 addresses aphasia assessment. Choose 96125 when the service is standardized testing of cognitive performance rather than an assessment focused on aphasia.
On this page
CMS RVU26D · Effective 2026-10-01
96125 Cognitive testing Medicare reimbursement rates in Colorado
Report standardized cognitive performance testing when a qualified health professional administers tests, interprets results, and prepares a clinical report. Compare 96125 office and facility rates across CMS payment localities in Colorado.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 96125 in Colorado?
Colorado has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$106.13
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Cognitive assessment
About 96125: Standardized cognitive performance testing
Report standardized cognitive performance testing when a qualified health professional administers tests, interprets results, and prepares a clinical report.
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.
CMS billing rules for 96125
- Professional and technical components
- Therapy service: the professional component modifier does not apply.
- Multiple procedures
- Therapy multiple procedure payment reduction: practice expense is reduced for the second and later therapy units on the same day.
Where the value comes from
- Work RVU1.70 · 55%
- Practice expense (office) RVU1.34 · 44%
- Malpractice RVU0.04 · 1%
11.2K
Medicare services in 2024 · #1418 by national volume
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.
96125 compared with similar codes
Office rates for Colorado, from the same CMS release.
$96.42
96116 describes a neurobehavioral status examination. 96125 is used for standardized cognitive performance testing, including test administration and interpretation.
$124.96
96132 covers neuropsychological testing evaluation. Use 96125 for the distinct therapy service of standardized cognitive performance testing.
$45.41
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.
Compare 96125 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Colorado →
Office / nonfacility
$106.13
Facility
Unavailable
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 96125 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
12,753
- Code
- 96125
- Physician work
- 1.70
- Practice expense
- 1.34
- Malpractice
- 0.04
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.70 | × 1.012 | 1.7204 |
| Practice expense | 1.34 | × 1.064 | 1.4258 |
| Malpractice | 0.04 | × 0.781 | 0.0312 |
| Total RVUs | 3.1774 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Colorado$106.13
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.7 | 1.012 |
| Practice expense | 1.34 | 1.064 |
| Malpractice | 0.04 | 0.781 |
(1.7 × 1.012 + 1.34 × 1.064 + 0.04 × 0.781) × $33.4009 = $106.13
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
12,75096113,,Devel tst phys/qhp ea addl,A,,1.16,0.49,,0.16,,0.03,1.68,1.35,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,04,0,99,0.00,0.00,0.00
12,75196116,,Nubhvl xm phys/qhp 1st hr,A,,1.86,0.90,,0.24,,0.06,2.82,2.16,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,04,0,99,0.00,0.00,0.00
12,75296121,,Nubhvl xm phy/qhp ea addl hr,A,,1.71,0.54,,0.12,,0.01,2.26,1.84,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,04,0,99,0.00,0.00,0.00
12,75396125,,Cognitive test by hc pro,A,,1.70,1.34,,1.34,NA,0.04,3.08,3.08,7,XXX,0.00,0.00,0.00,5,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,75496127,,Brief emotional/behav assmt,A,,0.00,0.14,,0.14,NA,0.01,0.15,0.15,3,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,75596130,,Psycl tst eval phys/qhp 1st,A,,2.56,1.06,,0.33,,0.09,3.71,2.98,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,04,0,99,0.00,0.00,0.00
12,75696131,,Psycl tst eval phys/qhp ea,A,,1.96,0.62,,0.13,,0.01,2.59,2.10,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,04,0,99,0.00,0.00,0.00
3401112,CA,69,VISALIA,1.017,1.096,0.536
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899