Billing code 96113: Developmental testingMedicare rate & RVUs in Illinois
Report this add-on for each additional 30 minutes of physician or qualified health professional developmental test administration beyond the initial service.
Medicare pays $55.25–$57.76 for 96113 in the office in Illinois, from Rest Of Illinois to Chicago. 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 96113 covers
A physician or other qualified health care professional uses this service for additional time administering and evaluating standardized developmental tests. Testing may assess a child’s language, motor, cognitive, social, memory, or adaptive functioning when developmental delay or another developmental concern prompts a formal evaluation. It can occur in an office, clinic, or other setting where the clinician performs the assessment with the patient and, when relevant, family members.
Report 96113 only with 96112, the primary developmental-testing service, for qualifying time beyond its initial hour. The record should identify the testing performed, the functions assessed, total service time, and the scoring, interpretation, and report supporting the additional work. CMS classifies 96113 as an add-on code: it cannot be billed alone, and payment is within the primary service’s global-period context.
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 96113 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$55.25 to $57.76
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $57.76 | $46.69 |
| East St. Louis | $55.82 | $45.68 |
| Rest Of Illinois | $55.25 | $45.19 |
| Suburban Chicago | $57.60 | $46.28 |
How the 96113 rate is calculated
Each of 96113’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 · 96113
RVUs × geographic indexes × conversion factor
Work1.16
1.16 RVUs× 1.000 GPCI
Practice expense0.49
0.49 RVUs× 1.000 GPCI
Malpractice0.03
0.03 RVUs× 1.000 GPCI
Adjusted RVUs
1.6800
Conversion factor
$33.4009
Medicare rate
$56.11
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 96113
The CMS indicators that decide how 96113 is paid alongside other services.
CMS payment indicators · 96113
Developmental testing
| 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. |
96113 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 96112Developmental testing
- 96112 covers the initial hour of developmental testing; 96113 covers additional 30-minute increments and is reported with 96112.
- 96110Developmental screen w/score
- 96110 is for a brief developmental screen with a score. Use 96113 only for additional time in a formal developmental testing service.
- 96125Cognitive testing
- 96125 is for cognitive testing by a health care professional. 96113 extends developmental test administration beyond the initial hour.
96113 billing questions
How does 96113 differ from 96112?
96112 represents the initial hour of developmental testing. Use 96113 for each additional 30 minutes of qualifying testing time, paired with 96112.
Can 96113 be billed without 96112?
No. It is an add-on code and must be reported with 96112, the primary developmental-testing service.
Is 96113 appropriate for a brief developmental screen?
No. A brief screen with a score is represented by 96110; 96113 is for additional time in a formal developmental test service.
What documentation supports an additional unit?
Document the test activities, developmental functions assessed, total qualifying time, and the resulting scoring, interpretation, and report. The record should support each additional 30-minute unit billed.
Does a modifier allow 96113 to stand alone?
No. A modifier does not replace the required 96112 primary code pairing.
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
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