CPT 96112
Global XXX ActiveDevel tst phys/qhp 1st hr
CPT 96112 Billing & Documentation Guide
CPT code 96112 (Devel tst phys/qhp 1st hr) is classified under Psych Testing with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.56, a non-facility practice expense RVU of 1.05, and a malpractice RVU of 0.14, a total non-facility RVU of 3.75 and facility RVU of 3.2. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $127.86, though rates vary from $118.04 to $168.19 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 96112, 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 96112 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 96112 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 96112
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.56 | 2.56 |
| Practice Expense RVU | 1.05 | 0.5 |
| Malpractice RVU | 0.14 | 0.14 |
| Total RVU | 3.75 | 3.2 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 96112
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 | $132.6 | $110.87 | $127.9 - $147.99 | 29 |
| Florida | $129.8 | $111.37 | $126.06 - $133.84 | 3 |
| Georgia | $124.69 | $107.16 | $122.36 - $127.01 | 2 |
| Illinois | $128.63 | $110.88 | $124.83 - $132.08 | 4 |
| Michigan | $125.02 | $107.77 | $122.81 - $127.23 | 2 |
| North Carolina | $121.22 | $104.08 | $121.22 - $121.22 | 1 |
| New York | $135.04 | $114.55 | $122.11 - $141.36 | 5 |
| Ohio | $122.24 | $105.47 | $122.24 - $122.24 | 1 |
| Pennsylvania | $125.63 | $107.64 | $122.12 - $129.13 | 2 |
| Texas | $124.85 | $106.76 | $121.76 - $127.45 | 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 96112
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 96112 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0362T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0373T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 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 |
| 90791 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 90791 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 90792 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 90792 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 90832 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 90832 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 96112
What does CPT code 96112 mean? +
CPT code 96112 represents: Devel tst phys/qhp 1st hr. It's in the Psych Testing category with a global period of XXX.
What is the Medicare reimbursement for CPT 96112? +
The 2026 Medicare national average non-facility payment for CPT 96112 is $127.86. Rates range from $118.04 to $168.19 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 96112? +
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 96112? +
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 May 31, 2026.
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