CPT 96113
Global ZZZ ActiveDevel tst phys/qhp ea addl
CPT 96113 Billing & Documentation Guide
CPT code 96113 (Devel tst phys/qhp ea addl) is classified under Psych Testing with a global period indicator of ZZZ. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.16, a non-facility practice expense RVU of 0.49, and a malpractice RVU of 0.03, a total non-facility RVU of 1.68 and facility RVU of 1.35. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $57.48, though rates vary from $53.32 to $76.1 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 96113, 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 96113 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Add-on code (global concept does not apply)
MUE Limit (Medically Unlikely Edits)
Submitting more than 6 units of 96113 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 96113
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.16 | 1.16 |
| Practice Expense RVU | 0.49 | 0.16 |
| Malpractice RVU | 0.03 | 0.03 |
| Total RVU | 1.68 | 1.35 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 96113
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 | $60.04 | $47 | $57.88 - $67.14 | 29 |
| Florida | $57.12 | $46.06 | $55.9 - $58.32 | 3 |
| Georgia | $55.61 | $45.1 | $54.54 - $56.69 | 2 |
| Illinois | $56.61 | $45.96 | $55.25 - $57.76 | 4 |
| Michigan | $55.53 | $45.18 | $54.82 - $56.23 | 2 |
| North Carolina | $54.66 | $44.37 | $54.66 - $54.66 | 1 |
| New York | $60.2 | $47.91 | $55 - $62.55 | 5 |
| Ohio | $54.7 | $44.63 | $54.7 - $54.7 | 1 |
| Pennsylvania | $56.2 | $45.4 | $54.72 - $57.68 | 2 |
| Texas | $56 | $45.15 | $54.57 - $57.03 | 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 96113
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 96113 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 96113
What does CPT code 96113 mean? +
CPT code 96113 represents: Devel tst phys/qhp ea addl. It's in the Psych Testing category with a global period of ZZZ.
What is the Medicare reimbursement for CPT 96113? +
The 2026 Medicare national average non-facility payment for CPT 96113 is $57.48. Rates range from $53.32 to $76.1 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 96113? +
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 96113? +
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 July 16, 2026.
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