$78.09
96116 is the initial-hour service. Use 96121 for additional qualifying time when the documentation supports it.
On this page
CMS RVU26D · Effective 2026-10-01
96116 Neurobehavioral exam Medicare reimbursement rates in Connecticut
A physician or qualified health care professional uses this code for a clinical examination of cognitive and behavioral functioning, including interpretation and reporting. Compare 96116 office and facility rates across CMS payment localities in Connecticut.
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 96116 in Connecticut?
Connecticut 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
$98.17
1 of 1 localities have a supported rate.
Payment area: Connecticut
One mapped payment locality.
Facility setting
$74.43
1 of 1 localities have a supported rate.
Payment area: Connecticut
One mapped payment locality.
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.
Neurobehavioral assessment
About 96116: Neurobehavioral status examination
A physician or qualified health care professional uses this code for a clinical examination of cognitive and behavioral functioning, including interpretation and reporting.
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.
Where the value comes from
- Work RVU1.86 · 66%
- Practice expense (office) RVU0.90 · 32%
- Malpractice RVU0.06 · 2%
136.5K
Medicare services in 2024 · #473 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.
96116 compared with similar codes
Office rates for Connecticut, from the same CMS release.
$127.10
96116 reports a clinical neurobehavioral status examination. 96132 covers professional evaluation work associated with neuropsychological testing.
$107.74
96116 is a clinician-led assessment of cognitive and behavioral functioning; 96125 is for cognitive performance testing.
$101.57
96105 is specific to aphasia assessment. 96116 addresses a broader set of cognitive and behavioral abilities.
Compare 96116 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
Connecticut →
Office / nonfacility
$98.17
Facility
$74.43
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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 96116 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
12,751
- Code
- 96116
- Physician work
- 1.86
- Practice expense
- 0.90
- Malpractice
- 0.06
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.86 | × 1.020 | 1.8972 |
| Practice expense | 0.90 | × 1.077 | 0.9693 |
| Malpractice | 0.06 | × 1.210 | 0.0726 |
| Total RVUs | 2.9391 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Connecticut$98.17
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.86 | 1.02 |
| Practice expense | 0.9 | 1.077 |
| Malpractice | 0.06 | 1.21 |
(1.86 × 1.02 + 0.9 × 1.077 + 0.06 × 1.21) × $33.4009 = $98.17
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.86 | 1.02 |
| Practice expense | 0.24 | 1.077 |
| Malpractice | 0.06 | 1.21 |
(1.86 × 1.02 + 0.24 × 1.077 + 0.06 × 1.21) × $33.4009 = $74.43
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.
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 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.
12,74896110,,Developmental screen w/score,N,+,0.00,0.36,,0.36,NA,0.01,0.37,0.37,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,04,0,99,0.00,0.00,0.00
12,74996112,,Devel tst phys/qhp 1st hr,A,,2.56,1.05,,0.50,,0.14,3.75,3.20,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,04,0,99,0.00,0.00,0.00
12,75096113,,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
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
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808