Summary & Overview
CPT 96116: Neurobehavioral Status Examination, First Hour
Headline: CPT 96116: One-Hour Neurobehavioral Status Exam for Cognitive and Behavioral Assessment
Lead: CPT 96116 designates a one-hour neurobehavioral status examination performed by a qualified clinician that evaluates cognitive domains such as attention, memory, language, reasoning, planning and visual-spatial abilities. This clinical assessment includes both patient contact and the clinician’s time interpreting results and preparing the report.
What the code represents and why it matters: CPT 96116 captures a focused, time-based clinical assessment used to document cognitive and behavioral status in patients with neurologic or neuropsychiatric conditions. Nationally, it supports clinical decision-making, documents baseline and change over time, and provides a standardized way to bill for the clinician’s combined evaluation and reporting time.
Key payers covered: The document considers coverage and administrative context for major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: The publication summarizes the code’s clinical scope, contrasts related testing codes, outlines common billing modifiers and provider taxonomies, and lists typical diagnostic contexts where the exam is applied. It highlights operational considerations such as time reporting (first hour) and links to adjacent codes for additional testing or subsequent hours. Any missing operational details are identified as not available in the input.
CPT Code Overview
CPT 96116 is a neurobehavioral status examination performed by a physician or other qualified health care professional. It is a clinical assessment of thinking, reasoning, and judgment including domains such as acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities. The code covers both face-to-face time with the patient and time spent interpreting test results and preparing the report; first hour.
Service type: Neurobehavioral status examination / Psychological and Neuropsychological Testing
Typical site of service: Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a history of traumatic brain injury and progressive memory complaints is referred for a neurobehavioral status examination. The referring neurologist documents new difficulties with attention, recent memory, and problem-solving consistent with suspected cognitive decline. A clinical neuropsychologist or psychologist conducts a face-to-face assessment that includes structured interview, brief standardized testing of attention, memory, language, visuospatial skills, and executive functioning, followed by interpretation of findings and preparation of a written report. The visit typically includes direct patient contact time (interview and testing) plus additional time for scoring, interpretation, and report generation as described by the neurobehavioral status exam code 96116 (first hour).
Coding Specifications
-
Modifier
26(Professional Component): Used when reporting only the professional component of the service (evaluation, interpretation, and report) when a separate entity provides the technical component. Applies when the billing practitioner provides the clinical interpretation and report but not the technical administration or provisioning of testing materials. -
Modifier
59(Distinct Procedural Service): Used when the neurobehavioral status exam is separate and distinct from other services provided on the same day (for example, when a separate psychotherapy or medical visit is performed). Indicates a distinct procedural service rather than a component of another billed service. -
Associated provider taxonomies:
| Taxonomy Code | Specialty |
|---|---|
103G00000X | Clinical Neuropsychologist |
103T00000X | Psychologist |
2084P0800X | Psychiatry Physician |
Related Diagnoses
-
F07.9— Personality and behavioral disorder due to known physiological condition, unspecifiedRelevance: Cognitive and behavioral changes from a physiological condition can be evaluated with a neurobehavioral status exam to document impairments in thinking, judgment, and behavior.
-
F09— Unspecified mental disorder due to known physiological conditionRelevance: When an etiologic physiological condition produces neurocognitive or psychiatric symptoms,
96116can be used to assess the cognitive profile and functional impairments. -
R41.3— Other amnesiaRelevance: Objective assessment of memory function is a core component of the neurobehavioral status exam to characterize the type and severity of amnesia.
-
R41.840— Attention and concentration deficitRelevance: The neurobehavioral status exam evaluates attention and concentration deficits through targeted testing and clinical observation.
-
R41.841— Cognitive communication deficitRelevance: Assessment of language, pragmatic communication, and cognitive-communication skills is part of the neurobehavioral status exam to document communication-related deficits.
Related CPT Codes
| CPT Code | Description | Relationship to 96116 |
|---|---|---|
96121 | Neurobehavioral status exam (each additional hour) | Used to report additional hours beyond the first hour captured by 96116. Commonly billed sequentially when assessment and interpretation exceed one hour. |
96105 | Assessment of aphasia and cognitive performance testing | Related alternative or complementary assessment focused on aphasia and specific cognitive performance; may be used when language-specific evaluation is primary rather than a broader neurobehavioral status exam. |
96136 | Psychological and Neuropsychological Test Administration and Scoring (multiple tests) | Represents time for administration and scoring of tests; may be billed in workflows where individual test administration/scoring is itemized instead of or in addition to the status exam. |
96137 | Psychological and Neuropsychological Test Administration and Scoring (multiple tests) | Paired with 96136 as the professional component for test administration and scoring when applicable; used in multi-component testing workflows. |
96138 | Psychological and Neuropsychological Test Administration and Scoring (multiple tests) | Alternate code in the series for administration/scoring; relates to detailed test administration workflows that can be reported instead of or alongside 96116. |
96139 | Psychological and Neuropsychological Test Administration and Scoring (multiple tests) | Part of the administration/scoring code set; used when itemizing test administration time and scoring rather than only the status exam. |
96146 | Psychological and Neuropsychological Testing with Automated Administration and Scoring | Used when testing is administered and scored via automated means; may be an alternative or adjunct to 96116 depending on testing modality. |
- Usage notes: Codes in the
9613xand96146series are commonly used together with or as alternatives to96116depending on whether the workflow itemizes test administration/scoring or reports a combined neurobehavioral status examination.96121is used to extend96116for additional hourly time.
National Reimbursement Benchmarks
National mean rates show commercial averages above Medicare for 96116: Medicare's mean allowed rate is $97.00 while the BUCA (average commercial benchmark) mean is $120.01, indicating commercial reimbursements are generally higher than Medicare by $23.01 on average. Among national payers, UnitedHealth Group posts the highest mean at $148.50 and Medicare the lowest at $97.00.
Rate dispersion (P75 − P25) varies by payer. UnitedHealth Group has one of the widest interquartile ranges (about $85.83) driven by a high P75 ($180.33) and a relatively low P25 ($94.50). Cigna also shows wide dispersion (about $61.50). In contrast, Medicare is the tightest with a range of $6.00 between the 25th and 75th percentiles. Aetna and BCBS display moderate dispersion (Aetna ≈ $32.06; BCBS ≈ $42.97). The table and chart below present the full percentile and mean breakdown for each payer.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.