Assessment of emotional or behavioral problems
Medicare pricing data for 31,556 providers across 52 states
Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.
💡 What You Should Know
Assessment of emotional or behavioral problems (HCPCS code 96127) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $4.65, but hospitals typically charge $21.69 — a 4.7x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $4.65, your out-of-pocket cost would be approximately $0.93. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 4.7x more than what Medicare allows for this procedure. Medicare actually pays $3.30 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| New York | $6 | $29 | 2,064 | 72,114 | +21.1% |
| District of Columbia | $5 | $23 | 96 | 860 | +17.2% |
| New Jersey | $5 | $19 | 1,047 | 26,362 | +14.6% |
| California | $5 | $21 | 1,651 | 39,777 | +12.5% |
| Connecticut | $5 | $28 | 550 | 9,788 | +11.0% |
| Hawaii | $5 | $16 | 127 | 2,305 | +10.8% |
| Maryland | $5 | $19 | 1,145 | 34,916 | +7.5% |
| Massachusetts | $5 | $28 | 1,067 | 13,306 | +7.1% |
| Alaska | $5 | $26 | 145 | 2,676 | +5.2% |
| Pennsylvania | $5 | $28 | 872 | 58,030 | +4.3% |
| Illinois | $5 | $25 | 1,159 | 16,114 | +3.0% |
| Washington | $5 | $17 | 1,473 | 20,494 | +3.0% |
| Rhode Island | $5 | $13 | 130 | 1,530 | +2.8% |
| New Hampshire | $5 | $18 | 223 | 4,471 | +2.2% |
| Virginia | $5 | $18 | 740 | 9,236 | +2.2% |
| Colorado | $5 | $20 | 768 | 16,471 | +1.7% |
| Florida | $5 | $17 | 1,462 | 28,078 | +1.1% |
| Montana | $5 | $14 | 113 | 4,185 | -0.2% |
| Nevada | $5 | $23 | 236 | 9,463 | -0.2% |
| Delaware | $5 | $44 | 226 | 25,990 | -1.1% |
| Oregon | $5 | $19 | 810 | 13,024 | -1.5% |
| Wyoming | $5 | $23 | 40 | 454 | -1.7% |
| North Dakota | $5 | $12 | 60 | 2,766 | -2.8% |
| Maine | $5 | $20 | 51 | 344 | -3.0% |
| Vermont | $4 | $23 | 49 | 1,405 | -3.4% |
| Minnesota | $4 | $28 | 567 | 6,269 | -3.7% |
| Arizona | $4 | $15 | 850 | 22,356 | -3.9% |
| Michigan | $4 | $16 | 1,601 | 21,215 | -4.3% |
| South Dakota | $4 | $24 | 41 | 329 | -5.2% |
| Texas | $4 | $24 | 2,480 | 69,077 | -6.2% |
| New Mexico | $4 | $21 | 210 | 5,098 | -7.5% |
| North Carolina | $4 | $15 | 1,413 | 22,778 | -8.2% |
| Wisconsin | $4 | $26 | 449 | 3,002 | -8.8% |
| Missouri | $4 | $24 | 308 | 4,766 | -9.7% |
| South Carolina | $4 | $12 | 193 | 7,940 | -10.1% |
| Utah | $4 | $20 | 372 | 7,253 | -10.1% |
| Georgia | $4 | $24 | 644 | 12,653 | -10.3% |
| Ohio | $4 | $15 | 693 | 7,291 | -10.8% |
| Louisiana | $4 | $18 | 324 | 10,280 | -11.0% |
| West Virginia | $4 | $14 | 162 | 1,974 | -11.2% |
| Kansas | $4 | $18 | 135 | 3,472 | -11.6% |
| Indiana | $4 | $15 | 944 | 21,100 | -12.0% |
| Iowa | $4 | $44 | 486 | 9,207 | -12.0% |
| Oklahoma | $4 | $13 | 400 | 21,558 | -12.7% |
| Tennessee | $4 | $14 | 1,001 | 20,923 | -14.0% |
| Kentucky | $4 | $21 | 572 | 7,263 | -14.2% |
| Idaho | $4 | $14 | 286 | 6,374 | -15.1% |
| Alabama | $4 | $10 | 316 | 24,375 | -16.6% |
| Mississippi | $4 | $14 | 257 | 5,645 | -17.0% |
| Nebraska | $4 | $23 | 281 | 3,100 | -17.8% |
| Puerto Rico | $4 | $8 | 44 | 237 | -18.1% |
| Arkansas | $4 | $18 | 186 | 6,235 | -19.8% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber