Neuropsych Testing Cost by State: Billed Rates vs Medicare

First hour of neuropsychological testing evaluation, by state: what should you know?

Code 96132, office setting, calendar year 2024 Medicare claims.

Nationally the code was billed at $317.32 and allowed at $124.09, across 6,086 clinicians.

What the clinician count tells you: what should you know?

The right-hand column is supply. A state with few billing clinicians is usually a state with a long wait, not a bargain.

Counts are Medicare-billing clinicians only. Practices that decline insurance are invisible here, and in some metros they are a large share of capacity.

Reading a state figure honestly: what should you know?

These are averages across a whole state. A large metro and a rural county sit inside the same number.

CMS hides any cell covering fewer than 11 patients, so smaller states may show as not published. We leave those blank rather than filling them.

Questions to ask a local practice: what should you know?

• What is the wait for an evaluation appointment?
• Do you bill insurance, or are you self-pay only?
• What is your rate for the first evaluation hour?
• How many total hours do you typically bill?

Common mistake: choosing a state figure over a local quote. The figure is context; the quote is the price.

How can you compare two written evaluation quotes?

Make a separate row for each part of the proposed evaluation: the interview, testing, scoring, report preparation and feedback. Copy the practice's description rather than assuming every hour is the first evaluation hour shown in this table. Leave a blank wherever the practice has not supplied a price or an expected quantity. A blank is a question to resolve before booking, not a zero-dollar service.

Ask whether the estimate is a package price or an hourly estimate. For a package, request the included services and the circumstances that could change the total. For an hourly estimate, request the expected units for each service and ask how the practice handles additional time. Do not multiply every proposed hour by the state row here: that row describes one billing code, not every component of an evaluation.

Keep the practice's estimate separate from the insurer's explanation of your benefits. Ask which services the practice expects to submit, whether it is in your network, and how to obtain a benefit estimate using those proposed services. Record who supplied each answer and when. Neither a historical Medicare average nor a receptionist's general description establishes what your own plan will pay.

Finally, compare the same scope on both quotes. If one includes the report and feedback while the other leaves them unspecified, ask for clarification before treating the second quote as less expensive. Keep travel and time away from work in a separate column so you can see the practical difference without presenting those personal expenses as clinical charges. The useful result is a documented comparison of two offers, not a prediction drawn from a state average.

Where these numbers come from, and what they are not: what should you know?

Method: we pull the published rows for each billing code, keep the average submitted charge and the average Medicare allowed amount, and print them unchanged. Nothing is modelled, averaged across codes, or adjusted.

• The submitted charge is what clinicians billed. It is list price. Almost nobody pays it.
• The allowed amount is what Medicare permitted, including the patient's coinsurance. It is a negotiated price.
• These are Medicare fee-for-service claims. The patients skew 65 and older.
• If you are paying cash or using commercial insurance, neither figure is your price. Use the gap between them as a bargaining range, not a quote.
• CMS hides any cell covering fewer than 11 patients, so some states are missing. We print "not published" there rather than guessing.

Common mistake: reading the allowed amount as "the real price" and expecting a clinic to match it. It is what one payer pays one set of clinicians.