Medicine · 96116
Exam Of Neurobehavioral Status, First Hour
What Medicare pays for 96116, what providers bill, and how the price varies across 53 states, drawn from CMS 2023 claims data.
- $68.88
- Medicare pays
- $255.88
- Providers bill
- 3.7×
- Markup
- #1,029 of 9,297
- Volume rank
The verdict
Exam Of Neurobehavioral Status, First Hour pairs top-quartile national service volume with one of the smaller markups in the catalog.
- Top 11%
- national service volume
- 18th pct.
- billed-to-Medicare markup
- 3.7×
- billed vs. Medicare
- $68.88
- Medicare pays, national avg
Volume percentile ranks this code's national service volume against every tracked procedure; markup percentile ranks its billed-to-Medicare ratio the same way. The same two figures drive both the verdict sentence and the chips above.
According to the Centers for Medicare & Medicaid Services (CMS), the 2023 Medicare Physician & Other Practitioners dataset records payments for 9,297 procedure codes billed across 5,426 hospitals in 56 states and territories; see our methodology for how each figure is sourced and computed.
Jurisdiction coverage for this code
56states and territories in the CMS extract
Price Range Across States
What You Might Pay
Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
How we estimate these prices
These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024). We map each PlainProcedure category onto a RAND CPT-section bucket (Surgery, Radiology, Pathology and Laboratory, Medicine, Anesthesia, Evaluation and Management) or fall back to the national average when no bucket matches. For Medicine, the applied ratio is 2.15x Medicare (RAND 2024 Medicine bucket (2.15x) + CMS Medicare baseline). Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.
Where this markup sits nationally
Markup (billed ÷ Medicare) across 8,901 procedures with a meaningful Medicare rate
4 more affordable than 18% of 8,901 procedures
Each bar is a 1-wide band; taller bars hold more procedures. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.
Source CMS Medicare Physician & Other Practitioners · 2023
What the billed charge breaks down into
$255.88
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| Alaska | $91.89 | $467.81 |
| Maryland | $75.96 | $255.57 |
| New York | $75.77 | $302.68 |
| District of Columbia | $74.65 | $244.56 |
| Guam | $74.08 | $98.14 |
| New Jersey | $72.38 | $228.28 |
| California | $72.05 | $223.06 |
| Delaware | $71.82 | $191.86 |
| Massachusetts | $71.78 | $297.63 |
| Nevada | $70.12 | $183.43 |
| Florida | $70.05 | $241.61 |
| Rhode Island | $69.59 | $196.38 |
| Hawaii | $69.40 | $210.10 |
| Illinois | $68.61 | $330.42 |
| Minnesota | $68.50 | $368.41 |
| Arizona | $68.00 | $209.13 |
| New Hampshire | $67.95 | $166.00 |
| Washington | $67.94 | $277.85 |
| Texas | $67.87 | $252.08 |
| Connecticut | $67.76 | $254.10 |
| Pennsylvania | $67.61 | $237.99 |
| Colorado | $67.41 | $335.57 |
| Virginia | $67.23 | $246.78 |
| Missouri | $67.00 | $254.87 |
| Michigan | $66.84 | $208.38 |
| Wyoming | $66.59 | $327.23 |
| Puerto Rico | $66.37 | $92.41 |
| Georgia | $66.08 | $234.02 |
| Oregon | $65.20 | $202.05 |
| Nebraska | $64.93 | $256.85 |
| Indiana | $64.90 | $287.73 |
| Ohio | $64.89 | $303.99 |
| Oklahoma | $64.83 | $183.35 |
| Kentucky | $64.72 | $291.71 |
| South Dakota | $64.68 | $127.88 |
| South Carolina | $64.66 | $233.31 |
| West Virginia | $64.53 | $269.17 |
| Montana | $64.37 | $190.89 |
| Mississippi | $64.20 | $276.96 |
| Maine | $64.11 | $311.00 |
| Vermont | $63.93 | $322.17 |
| North Carolina | $63.66 | $239.32 |
| Utah | $63.19 | $201.87 |
| Louisiana | $63.13 | $215.67 |
| New Mexico | $63.13 | $219.57 |
| Kansas | $62.12 | $349.61 |
| Wisconsin | $62.10 | $554.57 |
| Idaho | $62.07 | $190.28 |
| Tennessee | $61.35 | $255.07 |
| Iowa | $61.16 | $239.15 |
| Arkansas | $61.06 | $217.64 |
| Alabama | $59.59 | $156.20 |
| North Dakota | $56.71 | $111.55 |
What the Data Says About Exam Of Neurobehavioral Status, First Hour
Across 53 states with reporting providers, CPT code 96116 (Exam Of Neurobehavioral Status, First Hour) shows a national average Medicare payment of $68.88 against an average billed charge of $255.88. That gap, a 3.7x markup, or 271% above the Medicare allowed amount, is among the tightest billed-to-paid spreads we track, this code's chargemaster rate tracks unusually close to the Medicare benchmark.
Medicine procedures like this one saw 133.6K services billed to Medicare in 2023 by 4.3K distinct providers, serving 118.9K unique beneficiaries. State-level variation is significant: North Dakota reports the lowest average payment at $56.71, while Alaska reports the highest at $91.89. A 62% spread this wide is typically a GPCI story: practice-expense and malpractice-premium components of the fee formula diverge sharply by locality even though the procedure code never changes. Applying the RAND 2024 commercial-to-Medicare ratio for this category (2.15x Medicare; RAND 2024 Medicine bucket (2.15x) + CMS Medicare baseline), the estimated commercial insurance price lands near $193.26, with self-pay cash discounts commonly bringing the figure closer to $137.78. Within Medicine, Exam Of Neurobehavioral Status, First Hour ranks #218 of 533 tracked procedures by national average Medicare payment.
Where this sits in the registry
Exam Of Neurobehavioral Status, First Hour (96116) is a CMS 2023 Part B code. These pages keep the volume map and the markup map separate.
- National volume versus markup on the statistics page, the same two maps as this capsule. Statistics
- Other Medicine codes, ranked by Medicare payment inside the category. Category
- How volume rank and markup rank are computed. Methodology
- The full procedures listing in volume order. Procedures
Figures here are CMS averages, not a quote for any patient, plan, or visit.
Frequently Asked Questions
Where does Exam Of Neurobehavioral Status, First Hour rank among Medicare procedures?
According to CMS Medicare Part B claims, Exam Of Neurobehavioral Status, First Hour (CPT 96116) ranks #1,029 of 9,297 procedures by national service volume, the same sort as the procedures listing, and #218 of 533 within Medicine by national average Medicare payment. See /methodology#corpus-placement.
How much does Exam Of Neurobehavioral Status, First Hour cost?
Medicare's national average payment for Exam Of Neurobehavioral Status, First Hour (CPT 96116) is $68.88, with providers billing $255.88 on average; state rates run from $56.71 to $91.89, a meaningful but not extreme spread.
Why do providers charge more than Medicare pays?
Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.
How much does Exam Of Neurobehavioral Status, First Hour cost with insurance?
With commercial insurance, exam of neurobehavioral status, first hour costs an estimated $193.26 on average (range: $135.28-$270.56), a moderate premium over Medicare's $68.88. Without insurance, the estimated cash price is $137.78.
Which state has the lowest cost for Exam Of Neurobehavioral Status, First Hour?
North Dakota has the lowest average Medicare payment for Exam Of Neurobehavioral Status, First Hour at $56.71, while Alaska has the highest at $91.89 - a meaningful $35.18 spread.
How many providers perform Exam Of Neurobehavioral Status, First Hour?
A moderate provider base performs Exam Of Neurobehavioral Status, First Hour: 4.3K providers nationally, totaling 133.6K Medicare-billed services (118.9K beneficiaries) across 53 states in 2023.
What is the billed-to-Medicare markup for Exam Of Neurobehavioral Status, First Hour?
Providers bill 3.7x what Medicare pays for Exam Of Neurobehavioral Status, First Hour - one of the smaller markups in the catalog at 271% above the Medicare rate.
Nationwide similar CPT codes
Data-derived peers across the CMS Physician & Other Practitioners extract: nearest national service volume and nearest average Medicare payment. Not clinical substitutes: claim-mass and payment neighborhoods only.
Closest national service volume
Nearest codes with ≥100 services (133.6K here).
Closest average Medicare payment
Nearest codes with payment ≥ $5 ($68.88 here).
Related Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, the data changelog, or report a data error.