CPT 96113

Developmental Tst Admin Phys/Qhp Ea Addl 30 Min

CPT 96113 pays $56.11 in a non-facility setting and $45.09 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $53.32 in Arkansas to $76.10 in Alaska, a 43% spread.

National non-facility rate

$56.11

Office and other outpatient settings

Facility rate
$45.09

Hospital and ASC settings

Highest state
$76.10

Alaska

Lowest state
$53.32

Arkansas · 43% spread

Medicare rate by state

53 Medicare jurisdictions, highest to lowest. State values average every locality in the jurisdiction at a 33.4009 conversion factor.

Non-facilityFacilityNational $56.11
CPT 96113 Medicare reimbursement rate by state, 33.4009 conversion factor, 2026 Physician Fee Schedule. National non-facility $56.11, national facility $45.09.
StateRate compared visuallyNon-facilityFacility
Alaska
$76.10$64.36
District of Columbia
$61.23$48.25
New Jersey
$60.25$47.84
New York
$60.20$47.91
California
$60.04$47.00
Washington
$59.41$46.85
Massachusetts
$59.08$46.70
Connecticut
$58.36$46.49
Hawaii
$57.93$45.40
Colorado
$57.41$45.68
Maryland
$57.39$45.90
Rhode Island
$57.28$45.90
Florida
$57.12$46.06
Oregon
$57.02$45.41
New Hampshire
$56.66$45.19
Illinois
$56.61$45.96
Puerto Rico
$56.28$45.13
Virgin Islands
$56.28$45.13
Pennsylvania
$56.20$45.40
Montana
$56.11$45.09
Delaware
$56.01$45.12
Texas
$56.00$45.15
Nevada
$55.96$44.93
Minnesota
$55.88$44.54
Wyoming
$55.85$44.83
Georgia
$55.62$45.10
Virginia
$55.54$44.71
Michigan
$55.52$45.17
North Dakota
$55.52$44.50
Arizona
$55.46$44.78
South Dakota
$55.45$44.43
Vermont
$55.45$44.54
Utah
$55.03$44.67
Maine
$55.01$44.48
New Mexico
$54.96$44.85
Missouri
$54.75$44.64
Louisiana
$54.74$44.67
Wisconsin
$54.73$44.17
South Carolina
$54.72$44.53
Ohio
$54.70$44.63
North Carolina
$54.66$44.37
Indiana
$54.40$44.19
West Virginia
$54.40$44.82
Idaho
$54.28$44.14
Nebraska
$54.23$44.06
Kentucky
$54.21$44.41
Tennessee
$54.16$44.14
Oklahoma
$54.14$44.30
Iowa
$54.12$44.03
Kansas
$54.05$44.08
Alabama
$53.63$43.99
Mississippi
$53.58$44.09
Arkansas
$53.32$43.85

Commercial rates for 96113

Medicare is the floor, not the market. See what UHC, Aetna, Cigna and BCBS actually pay — down to the TIN.

See negotiated rates