Reimbursement
$94.19
Threshold
60m
2026 Status
Active
What is CPT Code 96116?
CPT 96116 is defined as: Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, e.g., acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), per hour of the physician's or other qualified health care professional's time, both face-to-face time with the patient and time interpreting test results and preparing the report.
This code is primarily used for Behavioral services. It falls under the category of Behavioral Health / Neuropsychological and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
1.55
Physician Effort
PE (Non-Fac)
1.2
Practice Expense
Malpractice
0.07
Risk Factor
Total RVU
2.82
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
longitudinal focus
CMS continues to prioritize early detection of cognitive decline; 96116 remains the gold standard for clinical (non-automated) assessment.
site neutrality
Facility vs Non-Facility PE values are often similar for 96116, recognizing the resource intensity of professional time regardless of setting.
efficiency shield
Exempt from the -2.5% efficiency adjustment as it is a time-based diagnostic/assessment service.
Administrative Framework
Global Period
000
Place of Service
NCCI Exclusions
Key Modifiers
Operational Requirements
minimum time
31 minutes (to bill the first hour)
staff type
Physician or other Qualified Health Care Professional (QHP)
frequency
Once per session; can be multiple units if time exceeds 1 hour (using add-on codes)
add on codes
96121
care plan requirement
Detailed clinical assessment report of cognitive domains: attention, language, memory, and executive function.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
Medicare is increasingly scrutinizing 'incident to' billing for 96116; ensure the billing provider is the one performing the assessment.
Common Clinical Scenarios
CMS Eligibility: Patients with known or suspected cognitive/behavioral impairment. Initial or follow-up assessment of neurocognitive status
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Billing Differentiation
VS 96127
96127 is for brief screening (e.g., PHQ-9); 96116 is a deep, professional cognitive assessment.
VS 96130
96130 is for psychological testing evaluation; 96116 is for neurobehavioral mental status assessment.
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