Reviewed by Chris Saviano
Key Takeaways
- Testing is billed in two parts: evaluation services (96130-96133), billed by the hour, and test administration and scoring (96136-96139), billed in 30-minute units.
- Who administers the tests determines the administration code: 96136 and 96137 for a psychologist or physician, 96138 and 96139 for a technician.
- Code 96146 covers a single automated test and is billed once regardless of time.
- Under CPT time rules, an hourly testing code needs at least 31 minutes. Medicare contractors require multi-day testing to be reported on the last date of service, while some commercial payers use the first.
- Missing prior authorization, especially from managed behavioral health organizations, is a common testing denial, and add-on codes must be billed with their base codes on the same claim.
A single psychological or neuropsychological testing episode can produce four or more CPT codes across several dates of service. Since 2019, CPT has separated the clinician’s evaluation work from test administration and scoring, and each part carries its own time unit, performer requirement, and payer-specific date-of-service rule.
What Are the CPT Codes for Psychological and Neuropsychological Testing?
Psychological and neuropsychological testing uses nine CPT codes in three groups: evaluation services, test administration and scoring, and automated testing. The American Psychological Association’s overview of the 2019 code set explains that the codes distinguish technical test administration and scoring from professional evaluation services.
| Code | Service | Performed by | Unit |
| 96130 | Psychological evaluation services | Physician or qualified health care professional | First hour |
| 96131 | Psychological evaluation services, add-on | Physician or qualified health care professional | Each additional hour |
| 96132 | Neuropsychological evaluation services | Physician or qualified health care professional | First hour |
| 96133 | Neuropsychological evaluation services, add-on | Physician or qualified health care professional | Each additional hour |
| 96136 | Test administration and scoring, two or more tests | Physician or qualified health care professional | First 30 minutes |
| 96137 | Test administration and scoring, add-on | Physician or qualified health care professional | Each additional 30 minutes |
| 96138 | Test administration and scoring, two or more tests | Technician | First 30 minutes |
| 96139 | Test administration and scoring, add-on | Technician | Each additional 30 minutes |
| 96146 | Single automated instrument with automated result | Electronic platform | Once per test, regardless of time |
Three related codes cover assessments that are not billed as testing. Neurobehavioral status exams, which assess thinking, reasoning, and judgment, use 96116 for the first hour and 96121 for each additional hour. Brief standardized screening instruments, such as a depression questionnaire given during a visit, use 96127 and do not qualify as testing.
What Is the Difference Between Evaluation Codes and Test Administration Codes?
Evaluation codes pay for the clinician’s professional judgment, and administration codes pay for giving and scoring the tests. According to the APA, evaluation services include:
- Selecting the tests to administer
- Integrating patient data and interpreting standardized test results and clinical data
- Clinical decision-making and treatment planning
- Writing the report and providing interactive feedback to the patient, family members, or caregivers, when performed
Administration and scoring codes cover the time spent giving two or more tests and scoring them, by any method. Most testing episodes include both: an administration code for the testing session and an evaluation code for interpretation, report writing, and feedback. Minutes billed to one code cannot also be counted toward the other.
Some payers do not allow psychological and neuropsychological evaluation codes in the same episode. Blue Cross and Blue Shield of Montana’s billing reminders direct providers to decide whether the testing is mainly psychological or neuropsychological and bill that family alone.
How Do You Bill Technician-Administered and Automated Tests?
When a technician gives and scores the tests, the practice bills 96138 for the first 30 minutes and 96139 for each additional 30 minutes, based on the technician’s face-to-face time with the patient. The supervising psychologist or physician still bills the evaluation codes for interpretation and the report. CMS’s testing FAQs state that Medicare authorizes physicians and clinical psychologists to provide general supervision of diagnostic psychological and neuropsychological tests, and that nurse practitioners, clinical nurse specialists, physician assistants, and certified nurse-midwives may supervise diagnostic tests within their scope of practice and state law. Contractors can set stricter terms: Wisconsin Physicians Service, a Medicare Administrative Contractor, describes testing by a technician under the clinician’s direct supervision in its billing article. Confirm the supervision rule with the practice’s contractor and each commercial payer.
Code 96146 covers one automated instrument administered on an electronic platform that produces an automated result. CMS states that 96146 is billed once regardless of the time the patient spends on the test. The APA notes that 96146 does not apply when two or more electronic tests are given, which are billed with the standard administration codes.
How Is Time Counted for Testing Codes?
Testing codes follow CPT’s general time rule: a unit of time is reached once the midpoint is passed. An hourly evaluation code such as 96130 or 96132 therefore needs at least 31 minutes, and the add-on 96131 or 96133 can be reported once total evaluation time reaches 91 minutes. A 30-minute administration code needs at least 16 minutes, and its add-on can be reported at 46 minutes. The WPS Medicare billing article states the same 31-minute minimum for any per-hour code.
Documentation should record the date and duration of each part of the service, split by code family. A record that lists total testing time without dividing administration from evaluation time cannot support both codes.
Which Date of Service Applies When Testing Spans Several Days?
Medicare contractors and many behavioral health payers require a multi-day testing episode to be reported on the last day. The WPS article instructs providers to combine time from all days and report it on the last date of service, and CMS’s FAQs say total time should be reported at the completion of the entire episode. Carelon Behavioral Health’s testing billing update takes the same approach, using the conclusion date for both the base code and its add-on codes and placing them on one claim.
Some commercial payers use a different rule. Blue Cross and Blue Shield of Montana instructs providers to use each base code once per testing episode, at the start of testing, when testing spans multiple days. A practice billing several commercial payers needs the date-of-service rule for each one documented before claims go out.
Does Psychological Testing Require Prior Authorization?
Commercial plans, Medicaid managed care plans, and managed behavioral health organizations often require prior authorization for psychological and neuropsychological testing, and missing authorization is a common denial reason. Carelon lists lack of prior authorization among its testing denial trends. Original Medicare does not require prior authorization for testing, but its contractors still expect the record to show why the testing was needed.
When a plan carves out behavioral health benefits, the testing authorization usually comes from the managed behavioral health organization, a routing issue covered in PGM’s post on behavioral health carve-outs. Many authorization request forms ask for the referral question, the tests planned, and the estimated hours of administration and evaluation, so a request that underestimates hours can leave part of the episode unauthorized.
When Is Psychological Testing Considered Medically Necessary?
Medicare covers testing when the results are expected to affect the patient’s treatment. The WPS article states that procedures with no effect on the plan of care are not medically necessary, and that Medicare’s statute does not extend coverage to screening. It also places testing for Alzheimer’s disease outside coverage once the diagnosis has already been made.
The medical record should state the referral question, the clinical reason for testing, and how the results will guide treatment. The diagnosis on the claim should be the condition that prompted the referral, and PGM’s ICD-10 codes for mental health page lists frequently billed codes.
What Causes Psychological Testing Claims to Deny?
Testing denials cluster around a handful of errors, most of which a pre-submission review such as PGM’s medical claim scrubber can catch:
- No prior authorization on file with the plan or managed behavioral health organization that manages the benefit
- Add-on codes billed without the base code, or on a different date or claim than the base code
- Base codes reported more than once for a single testing episode
- Psychological and neuropsychological evaluation codes billed together for one episode, with payers that prohibit it
- Overlapping time, such as testing hours billed for minutes already billed as a psychotherapy session
- Testing codes used for brief screening that belongs under 96127
- Hours that exceed the authorization, or documentation that does not separate administration time from evaluation time
Several of these overlap with the time-based rules for psychotherapy codes covered in PGM’s breakdown of the coding and billing mistakes behind denied behavioral and mental health claims, which also explains the diagnostic evaluation codes 90791 and 90792.
How PGM Supports Psychological Testing Billing
PGM has provided independent medical billing and revenue cycle management since 1981, with dedicated support for mental and behavioral health practices, including coding for psychological assessments. Services include eligibility and benefits verification, prior authorization support, coding review, claims submission, denial management and appeals, and payment posting and reporting across commercial, Medicare, and Medicaid payers.
If testing claims are denying or paying below expectations, talk to PGM’s behavioral health billing team. For what to expect from a specialized partner, see how to choose a behavioral health billing company.
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Frequently Asked Questions About Psychological Testing Codes
Can testing administration and evaluation be billed on the same day?
Yes. When the full episode happens on one day, the administration and evaluation codes are reported together on that date, with each code supported by its own documented time. When the episode spans several days, the payer’s date-of-service rule decides whether the codes go on the last day of testing or, for some commercial payers, the first.
Is 96127 a psychological testing code?
No. Code 96127 covers a brief emotional or behavioral assessment using a standardized instrument, such as a depression or anxiety questionnaire, with scoring and documentation. It is commonly billed with an office visit or therapy session. Validated rating scales of this kind are also a required element of collaborative care and behavioral health integration services, which are billed under their own monthly codes.
How is a neurobehavioral status exam different from neuropsychological testing?
A neurobehavioral status exam (96116 and 96121) is a clinical assessment of thinking, reasoning, and judgment, covering areas such as attention, memory, language, and planning and problem solving, performed by the clinician. Neuropsychological testing uses standardized test batteries with separate administration and evaluation codes. The two can occur for the same patient, with time documented separately for each.
Who can bill psychological testing under Medicare?
The WPS billing article lists clinical psychologists, independently practicing psychologists, nurse practitioners, clinical nurse specialists, and physician assistants, within their scope of practice and state law, along with physicians. Billing requires Medicare enrollment and appropriate state licensure.
What should a testing report include for billing purposes?
The report should state the referral question, the tests administered and dates, the time spent on administration and on evaluation, the results and their interpretation, the diagnosis, and treatment recommendations. That content supports both medical necessity and the time billed to each code.