CPT 96125
Global XXX ActiveCognitive test by hc pro
CPT 96125 Billing & Documentation Guide
CPT code 96125 (Cognitive test by hc pro) is classified under Psych Testing with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.7, a non-facility practice expense RVU of 1.34, and a malpractice RVU of 0.04, a total non-facility RVU of 3.08 and facility RVU of 3.08. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $105.8, though rates vary from $95.92 to $133.57 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 96125, 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 96125 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 2 units of 96125 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 96125
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.7 | 1.7 |
| Practice Expense RVU | 1.34 | 1.34 |
| Malpractice RVU | 0.04 | 0.04 |
| Total RVU | 3.08 | 3.08 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 96125
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 | $112.5 | $112.5 | $107.52 - $128.28 | 29 |
| Florida | $104.29 | $104.29 | $101.58 - $106.75 | 3 |
| Georgia | $101.16 | $101.16 | $98.3 - $104.03 | 2 |
| Illinois | $102.78 | $102.78 | $99.73 - $105.51 | 4 |
| Michigan | $100.69 | $100.69 | $99.15 - $102.22 | 2 |
| North Carolina | $99.39 | $99.39 | $99.39 - $99.39 | 1 |
| New York | $111.22 | $111.22 | $100.24 - $116.11 | 5 |
| Ohio | $98.99 | $98.99 | $98.99 - $98.99 | 1 |
| Pennsylvania | $102.56 | $102.56 | $99.13 - $105.99 | 2 |
| Texas | $102.4 | $102.4 | $98.75 - $105.43 | 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 96125
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 96125 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 |
| 96127 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 96146 | Column 1 (primary), can be billed with modifier | No | More extensive procedure |
| 96160 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 96160 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 96161 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 96161 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 96523 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 97151 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 96125
What does CPT code 96125 mean? +
CPT code 96125 represents: Cognitive test by hc pro. It's in the Psych Testing category with a global period of XXX.
What is the Medicare reimbursement for CPT 96125? +
The 2026 Medicare national average non-facility payment for CPT 96125 is $105.8. Rates range from $95.92 to $133.57 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 96125? +
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 96125? +
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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