Billing code 96121: Neurobehavioral examMedicare rate & RVUs in Florida
Reports additional physician or qualified health care professional time assessing cognitive and behavioral functioning beyond the initial neurobehavioral status examination.
Medicare pays $74.86–$76.74 for 96121 in the office in Florida, from Rest Of Florida to Miami. 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.
On this page 9 sections
What 96121 covers
This add-on reports additional professional time spent evaluating cognitive and behavioral functioning, such as attention, memory, language, reasoning, judgment, planning, and problem solving. A physician or other qualified health care professional may perform the assessment in an office, hospital, or other appropriate setting when a patient has concerns such as cognitive changes after a brain injury, stroke, or suspected dementia. The service can include clinical assessment, review and interpretation of relevant findings, and preparation of the report.
Report 96121 only with 96116, the initial-hour neurobehavioral status examination. Documentation should identify the clinical concern, assessment performed, findings, and the time supporting the additional hour. This is an add-on code: CMS pays it only when reported with its primary procedure, and its payment falls within that procedure’s global period. Do not report it as a stand-alone service.
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 96121 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
$74.86 to $76.74
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | $75.99 | $61.78 |
| Miami | $76.74 | $62.13 |
| Rest Of Florida | $74.86 | $61.45 |
How the 96121 rate is calculated
Each of 96121’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 · 96121
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.71Practice expense 0.54Malpractice 0.01
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 96121
The CMS indicators that decide how 96121 is paid alongside other services.
CMS payment indicators · 96121
Neurobehavioral exam
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| 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 | 0 | Physician service: no professional/technical split. |
96121 compared with similar codes
Compare codes
96121 vs 96116 vs 96132 vs 96125: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 96116Neurobehavioral exam
- 96116 reports the initial hour of the neurobehavioral status examination. Use 96121 only for additional time and only with 96116.
- 96132Neuropsychological evaluation
- 96132 is the initial-hour code for neuropsychological testing evaluation. Choose it for that evaluation service, not additional time on a 96116 neurobehavioral status examination.
- 96125Cognitive testing
- 96125 describes cognitive performance testing by a health care professional. It is not the additional-hour code for the clinical neurobehavioral assessment reported with 96116.
96121 billing questions
What must be reported with 96121?
Report 96121 with 96116, which covers the initial hour of the neurobehavioral status examination. CMS treats 96121 as an add-on and pays it within the primary procedure’s global period.
How is 96121 different from 96116?
96116 reports the initial-hour service; 96121 reports additional time for that same neurobehavioral assessment. Do not use 96121 by itself.
How is this different from neuropsychological testing evaluation?
96121 extends a clinical neurobehavioral status examination. Codes 96132 and 96133 are for neuropsychological testing evaluation, a distinct service; select based on the work actually performed and documented.
What documentation supports an additional unit?
Document the assessment activities, relevant findings, and time attributable to the additional service. The record should make clear that the work extends the 96116 examination rather than describing a separate service.
Can 96121 be billed for testing administration?
96121 reports additional neurobehavioral assessment time, not test administration and scoring by themselves. For psychological or neuropsychological test administration and scoring, consider the applicable testing codes when that work was 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
Show the CMS file lines behind this rate
Fee sheets
Put 96121 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →