$120.96
96112 covers the initial hour of developmental testing; 96113 covers additional 30-minute increments and is reported with 96112.
On this page
CMS RVU26D · Effective 2026-10-01
96113 Developmental testing Medicare reimbursement rates in Kentucky
Report this add-on for each additional 30 minutes of physician or qualified health professional developmental test administration beyond the initial service. Compare 96113 office and facility rates across CMS payment localities in Kentucky.
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 96113 in Kentucky?
Kentucky 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
$54.21
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
Facility setting
$44.41
1 of 1 localities have a supported rate.
Payment area: Kentucky
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.
Developmental testing
About 96113: Additional developmental test administration
Report this add-on for each additional 30 minutes of physician or qualified health professional developmental test administration beyond the initial service.
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.
CMS billing rules for 96113
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
Where the value comes from
- Work RVU1.16 · 69%
- Practice expense (office) RVU0.49 · 29%
- Malpractice RVU0.03 · 2%
734
Medicare services in 2024 · #3222 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.
96113 compared with similar codes
Office rates for Kentucky, from the same CMS release.
96110
No office rateDevelopmental 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.
$97.79
96125 is for cognitive testing by a health care professional. 96113 extends developmental test administration beyond the initial hour.
Compare 96113 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
Kentucky →
Office / nonfacility
$54.21
Facility
$44.41
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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 96113 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
12,750
- Code
- 96113
- Physician work
- 1.16
- Practice expense
- 0.49
- Malpractice
- 0.03
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.16 | × 1.000 | 1.1600 |
| Practice expense | 0.49 | × 0.889 | 0.4356 |
| Malpractice | 0.03 | × 0.915 | 0.0274 |
| Total RVUs | 1.6231 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kentucky$54.21
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.16 | 1 |
| Practice expense | 0.49 | 0.889 |
| Malpractice | 0.03 | 0.915 |
(1.16 × 1 + 0.49 × 0.889 + 0.03 × 0.915) × $33.4009 = $54.21
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.16 | 1 |
| Practice expense | 0.16 | 0.889 |
| Malpractice | 0.03 | 0.915 |
(1.16 × 1 + 0.16 × 0.889 + 0.03 × 0.915) × $33.4009 = $44.41
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.
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 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.
12,74796105,,Assessment of aphasia,A,,1.75,1.11,,1.11,NA,0.05,2.91,2.91,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,04,0,99,0.00,0.00,0.00
12,74896110,,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
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631