CPT 96116
Global XXX ActiveNubhvl xm phys/qhp 1st hr
CPT 96116 Billing & Documentation Guide
CPT code 96116 (Nubhvl xm 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 1.86, a non-facility practice expense RVU of 0.9, and a malpractice RVU of 0.06, a total non-facility RVU of 2.82 and facility RVU of 2.16. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $96.48, though rates vary from $88.98 to $126.31 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 96116, 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 96116 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 96116 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 96116
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.86 | 1.86 |
| Practice Expense RVU | 0.9 | 0.24 |
| Malpractice RVU | 0.06 | 0.06 |
| Total RVU | 2.82 | 2.16 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 96116
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 | $101.01 | $74.92 | $97.2 - $113.38 | 29 |
| Florida | $96.19 | $74.07 | $93.88 - $98.49 | 3 |
| Georgia | $93.3 | $72.26 | $91.33 - $95.26 | 2 |
| Illinois | $95.22 | $73.92 | $92.7 - $97.37 | 4 |
| Michigan | $93.17 | $72.48 | $91.83 - $94.51 | 2 |
| North Carolina | $91.45 | $70.89 | $91.45 - $91.45 | 1 |
| New York | $101.33 | $76.74 | $92.09 - $105.57 | 5 |
| Ohio | $91.59 | $71.46 | $91.59 - $91.59 | 1 |
| Pennsylvania | $94.28 | $72.68 | $91.62 - $96.93 | 2 |
| Texas | $93.92 | $72.22 | $91.34 - $95.83 | 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 96116
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 96116 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 |
| 0362T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0820T | 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 |
| 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 |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 96105 | Column 1 (primary), can be billed with modifier | Yes | More extensive procedure |
| 96105 | Column 1 (primary), can be billed with modifier | Yes | More extensive procedure |
| 96110 | Column 1 (primary), can be billed with modifier | Yes | More extensive procedure |
Frequently Asked Questions, CPT 96116
What does CPT code 96116 mean? +
CPT code 96116 represents: Nubhvl xm phys/qhp 1st hr. It's in the Psych Testing category with a global period of XXX.
What is the Medicare reimbursement for CPT 96116? +
The 2026 Medicare national average non-facility payment for CPT 96116 is $96.48. Rates range from $88.98 to $126.31 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 96116? +
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 96116? +
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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