CPT 96004
Global XXX ActivePhys review of motion tests
CPT 96004 Billing & Documentation Guide
CPT code 96004 (Phys review of motion tests) is classified under Neurology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.09, a non-facility practice expense RVU of 0.95, and a malpractice RVU of 0.14, a total non-facility RVU of 3.18 and facility RVU of 3.18. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $108.35, though rates vary from $99.47 to $141.08 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 96004, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 96004 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 96004 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 96004
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.09 | 2.09 |
| Practice Expense RVU | 0.95 | 0.95 |
| Malpractice RVU | 0.14 | 0.14 |
| Total RVU | 3.18 | 3.18 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 96004
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $112.39 | $112.39 | $108.28 - $125.75 | 29 |
| Florida | $110.75 | $110.75 | $107.17 - $114.67 | 3 |
| Georgia | $105.78 | $105.78 | $103.69 - $107.87 | 2 |
| Illinois | $109.65 | $109.65 | $106.09 - $112.92 | 4 |
| Michigan | $106.19 | $106.19 | $104.06 - $108.31 | 2 |
| North Carolina | $102.4 | $102.4 | $102.4 - $102.4 | 1 |
| New York | $114.87 | $114.87 | $103.24 - $120.69 | 5 |
| Ohio | $103.49 | $103.49 | $103.49 - $103.49 | 1 |
| Pennsylvania | $106.52 | $106.52 | $103.36 - $109.67 | 2 |
| Texas | $105.77 | $105.77 | $103.03 - $108.31 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 96004
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 96004 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 95860 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 95861 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 95863 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 95864 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 95865 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 95866 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 95867 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 95868 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 96004
What does CPT code 96004 mean? +
CPT code 96004 represents: Phys review of motion tests. It's in the Neurology category with a global period of XXX.
What is the Medicare reimbursement for CPT 96004? +
The 2026 Medicare national average non-facility payment for CPT 96004 is $108.35. Rates range from $99.47 to $141.08 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 96004? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 96004? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 2, 2026.
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