CPT 96116 Diagnostic
Neurobehavioral status examination, first hour Cost
Body System: Nervous
Medicare Facility Rate
$124
CMS PFS CY2026
Medicare Non-Facility Rate
$164
Office/clinic setting
Hospital Outpatient
$221
OPPS rate
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
2.80
Work RVU
0.92
Facility PE RVU
0.12
Malpractice RVU
Cost by Location
| Location | Medicare Rate | Est. Commercial |
|---|---|---|
| AK — ALASKA | $103 | $165 — $254 |
| AL — ALABAMA | $71 | $117 — $180 |
| AR — ARKANSAS | $70 | $116 — $179 |
| AZ — ARIZONA | $72 | $121 — $187 |
| CA — BAKERSFIELD | $74 | $127 — $196 |
| CA — CHICO | $73 | $127 — $195 |
| CA — EL CENTRO | $73 | $127 — $195 |
| CA — FRESNO | $73 | $127 — $195 |
| CA — HANFORD-CORCORAN | $73 | $127 — $195 |
| CA — LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) | $76 | $133 — $204 |
| CA — MADERA | $73 | $127 — $195 |
| CA — MERCED | $73 | $127 — $195 |
| CA — MODESTO | $73 | $127 — $195 |
| CA — NAPA | $78 | $139 — $214 |
| CA — OXNARD-THOUSAND OAKS-VENTURA | $75 | $132 — $202 |
| CA — REDDING | $73 | $127 — $195 |
| CA — REST OF CALIFORNIA | $73 | $127 — $195 |
| CA — RIVERSIDE-SAN BERNARDINO-ONTARIO | $74 | $128 — $197 |
| CA — SACRAMENTO-ROSEVILLE-FOLSOM | $75 | $131 — $202 |
| CA — SALINAS | $75 | $131 — $201 |
Frequently Asked Questions
How much does Neurobehavioral status examination, first hour cost?
The Medicare facility rate is $124. Commercial insurance typically pays 150-250% of Medicare rates (varies). Hospital outpatient rate: $221.
How much does Neurobehavioral status examination, first hour cost without insurance?
Without insurance, you may pay the hospital's chargemaster rate, which is often 300-500% of Medicare. Ask about cash-pay discounts — many facilities offer 20-40% off for self-pay patients. The Medicare baseline for this procedure is $124.