Purpose: Smaller pixel sizes of x-ray photon counting detectors (PCDs) benefit count rate capabilities but increase cross-talk and "double-counting" between neighboring PCD pixels. When an x-ray photon produces multiple (n) counts at neighboring (sub-)pixels and they are added during postacquisition N 9 N binning process, the variance of the final PCD output-pixel will be larger than its mean. In the meantime, anti-scatter grids are placed at the pixel boundaries in most of x-ray CT systems and will decrease cross-talk between sub-pixels because the grids mask sub-pixels underneath them, block the primary x-rays, and increase the separation distance between active sub-pixels. The aim of this paper was, first, to study the PCD statistics with various N 9 N binning schemes and three different masking methods in the presence of cross-talks, and second, to assess one of the most fundamental performances of x-ray CT: soft tissue contrast visibility. Methods: We used a PCD cross-talk model (Photon counting toolkit, PcTK) and produced crosstalk data between 3 9 3 neighboring sub-pixels and calculated the mean, variance, and covariance of output-pixels with each of N 9 N binning scheme [4 9 4 binning, 2 9 2 binning, and 1 9 1 binning (i.e., no binning)] and three different sub-pixel masking methods (no mask, 1-D mask, and 2-D mask). We then set up simulation to evaluate the soft tissue contrast visibility. X-rays of 120 kVp were attenuated by 10-40 cm-thick water, with the right side of PCDs having 0.5 cm thicker water than the left side. A pair of output-pixels across the left-right boundary were used to assess the sensitivity index (SI or d 0 ), which typically ranges 0-1 and is a generalized signal-to-noise ratio and a statistics used in signal detection theory. Results: Binning a larger number of sub-pixels resulted in larger mean counts and larger varianceto-mean ratio when the lower threshold of the energy window was lower than the half of the incident energy. Mean counts are in the order of no mask (the largest), 1-D mask, and 2-D mask but the difference in variance-to-mean ratio was small. For a given sub-pixel size and masking method, binning more sub-pixels degraded the normalized SI values but the difference between 4 9 4 binning and 1 9 1 binning was typically less than 0.06. 1-D mask provided better normalized SI values than no mask and 2-D mask for side-by-side case and the improvements were larger with fewer binnings, although the difference was less than 0.10. 2-D mask was the best for embedded case. The normalized SI values of combined binning, sub-pixel size, and masking were in the order of 1 9 1 (900 lm) 2 binning, 2 9 2 (450 lm) 2 binning, and 4 9 4 (225 lm) 2 binning for a given masking method but the difference between each of them were typically 0.02-0.05. Conclusion: We have evaluated the effect of double-counting between PCD sub-pixels with various binning and masking methods. SI values were better with fewer number of binning and larger subpixels. The difference among various binning and maskin...