CPT 96130: Billing Guide & FAQ (2026)

CPT 96130 is the billing code for psychological testing evaluation services performed by a physician or other qualified healthcare professional. As of January 2026, the Medicare national average reimbursement is $124.74 for the first hour. This code covers the professional work of interpreting test results, integrating clinical data, making treatment decisions, writing reports, and delivering feedback to patients — the cognitive evaluation that follows test administration.

Understanding 96130 is essential for any practice that administers psychological testing, because it captures the highest-value component of the testing workflow: the clinical interpretation and decision-making that only a qualified professional can perform. Below is a comprehensive guide covering eligibility, time requirements, reimbursement rates, modifier rules, and the most common billing questions providers ask.

What is CPT 96130?

96130 is defined as: “Psychological testing evaluation services by physician or other qualified healthcare professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour.”

This code captures the professional evaluation work that happens after screening instruments have been administered and scored. It is distinct from the administration codes (96136 for provider administration, 96138 for technician administration) and represents the clinical judgment portion of the testing workflow.

Who Can Bill 96130?

Any physician, mid-level, or qualified healthcare professional may bill 96130. This includes providers holding credentials such as MD, DO, PA, NP, DNP, PhD, or PsyD. CMS defines a qualified healthcare professional as an individual qualified by education, training, and licensure who performs a professional service within their scope of practice — there is no specialty restriction. Individual payer credentialing requirements may vary.

Who generally cannot bill 96130: Therapists, Licensed Social Workers, and technicians generally cannot bill 96130 under CMS guidelines. The evaluation services must be performed by the physician, mid-level, or QHP personally — they cannot be delegated. For test administration by a technician, see CPT 96138.

2026 Reimbursement Rates

Payer Type	Rate (First Hour)	Additional Hours (96131)
Medicare (national avg.)	$124.74	Check Medicare fee schedule
Commercial	Varies by payer and contract	Varies
Medicaid	Varies by state	Varies by state

CPT 96130 may be billed as often as medically necessary. While MUE limits do not restrict annual frequency, some individual payers may impose their own limits. Always verify with each payer.

Time Requirements

CPT 96130 is a time-based code covering the first hour of evaluation services. The key rules:

• Minimum time: 31 minutes of total time (half the defined hour plus one minute)
• Total time, not face time: The clock includes all evaluation activities, not just time spent directly with the patient
• What counts: Integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report writing, and interactive feedback to the patient, family member, or caregiver

If evaluation time exceeds one hour, bill each additional hour using CPT 96131. For example, if testing evaluation takes 3 hours total, bill 96130 (first hour) plus 96131 with 2 units (hours 2 and 3).

ICD-10 Codes for 96130

Medicare requires mental health-related ICD-10 codes for 96130 — generally codes beginning with F (mental health conditions) or codes for symptoms related to mental health conditions. Refer to the latest Medicare Billing and Coding Articles for the exact covered codes.

Major medical payers have similar requirements, generally accepting F-codes or symptom codes related to mental health conditions.

Critical rule: Do not use the same ICD-10 codes to justify both your E&M service and 96130, or the payer may consider 96130 bundled with the E&M and deny payment. Use distinct condition codes for each service.

Modifier Rules

When billing 96130 alongside an Evaluation and Management (E&M) code:

1. Bill the E&M code first with modifier 25 (significant, separately identifiable E&M service)
2. Bill 96130 last with modifier 59 (distinct procedural service)

This modifier pairing tells the payer that the testing evaluation was a separate, distinct service from the office visit. For detailed modifier examples and payer-specific guidance, download our complete billing guide.

96130 vs. 96136 vs. 96138: Understanding the Testing Code Family

The psychological testing codes work together as a system. Understanding which code captures which service is critical to avoid claim denials:

• 96130 (this code): Evaluation by a physician or QHP — interpreting results, clinical decisions, reports, feedback. First hour.
• 96131: Evaluation by a physician or QHP — each additional hour beyond the first.
• 96136: Test administration and scoring by a physician or QHP. First 30 minutes.
• 96137: Test administration and scoring by a physician or QHP. Each additional 30 minutes.
• 96138: Test administration and scoring by a technician. First 30 minutes.
• 96139: Test administration and scoring by a technician. Each additional 30 minutes.

The evaluation codes (96130/96131) and administration codes (96136–96139) can be billed together, and they do not need to be performed on the same day. A technician can administer and score tests on Day 1 (96138), and the physician can evaluate results and provide feedback on Day 2 (96130).

Telemedicine Billing

As of January 2026, CMS has approved CPT 96130 for use with telemedicine through December 31, 2026. Providers conducting virtual evaluation sessions — reviewing test results, providing clinical interpretation, and delivering feedback remotely — can bill 96130 with the appropriate telehealth modifier.

Codes That Cannot Be Billed With 96130

Do not bill 96130 on the same date of service as:

• 96127 (brief emotional/behavioral assessment)
• 99406–99409 (smoking/tobacco cessation counseling)
• 90791 (psychiatric diagnostic evaluation)
• 90792 (psychiatric diagnostic evaluation with medical services)
• Any psychotherapy codes (90832, 90834, 90837, etc.)

These exclusions exist because the services represented by those codes overlap with elements of the testing evaluation captured by 96130.

Documentation Requirements

To support 96130 claims, maintain records showing:

• Which standardized instruments were administered and evaluated
• Total time spent on evaluation activities (remember: minimum 31 minutes)
• Integration of patient data — what clinical history was considered
• Interpretation of results — scores and clinical significance
• Clinical decision making — diagnostic impressions and differential considerations
• Treatment plan — recommended interventions based on findings
• Feedback provided — documentation of patient/caregiver communication

Thorough documentation is especially important for 96130 because of its higher reimbursement rate. Payers are more likely to audit high-value testing claims.

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Official CMS Resources

• Medicare Billing and Coding Article for Psychological Testing
• CMS Telehealth Services List
• Medicare Physician Fee Schedule Lookup
• NCCI Medicare Coding Policies

Related Billing Resources

• CPT 96127 FAQ — Brief emotional/behavioral assessment
• CPT 96136 FAQ — Test administration by a provider
• CPT 96138 FAQ — Test administration by a technician
• New CPT codes for psychological testing — Overview of the 2019 code changes
• Mental Health Parity Act — Your rights when payers deny claims

Frequently Asked Questions

What is CPT code 96130?

CPT 96130 is the billing code for psychological testing evaluation services by a physician or other qualified healthcare professional, covering the first hour. It includes integration of patient data, interpretation of standardized test results, clinical decision making, treatment planning, report writing, and interactive feedback to the patient or caregiver.

How much does CPT 96130 pay in 2026?

As of January 2026, the Medicare national average reimbursement for CPT 96130 is $124.74 for the first hour. Commercial payer rates vary but are typically higher than Medicare.

Who can bill CPT 96130?

Any physician or qualified healthcare professional may bill 96130. CMS defines a QHP as an individual qualified by education, training, and licensure who performs a professional service within their scope of practice — there is no specialty restriction. Therapists, Licensed Social Workers, and technicians generally cannot bill 96130 under CMS guidelines. Individual payer credentialing requirements may vary.

Can the work for CPT 96130 be delegated to a technician?

No. CPT 96130 cannot be delegated to a technician. The evaluation services must be performed by a physician or other qualified healthcare professional (MD, DO, DNP, PA, NP, PhD, PsyD). For test administration by a technician, use CPT 96138 instead.

Is CPT 96130 time-based?

Yes. CPT 96130 is a time-based code covering the first hour of testing evaluation services. A minimum of 31 minutes of total time (not face time) must be spent to bill one unit. Time is calculated as total time, including all evaluation activities.

What does the time requirement for 96130 include?

The time requirement includes integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report writing, and interactive feedback to the patient, family member, or caregiver. This is total time, not face time.

What if CPT 96130 evaluation time exceeds one hour?

If evaluation time exceeds one hour, bill additional hours using CPT 96131. For example, if testing evaluation takes 3 hours, bill 96130 for the first hour and 96131 with 2 units for the remaining hours.

Which ICD-10 codes can I use with CPT 96130?

Medicare requires mental health-related ICD-10 codes, generally F-codes or codes for symptoms related to mental health conditions. Major medical payers have similar requirements. Do not use the same ICD-10 codes for both your E&M service and 96130, or the payer may consider 96130 bundled and deny payment.

What modifier should I use when billing CPT 96130?

When billing 96130 with an E&M code, bill the E&M code first with modifier 25 (significant, separately identifiable E&M service). Bill 96130 last with modifier 59 (distinct procedural service).

How many times per year can I bill CPT 96130?

CPT 96130 may be billed as often as medically necessary. While the MUE does not restrict annual frequency, some individual payers may limit how often 96130 can be billed per year. Check with each payer for their specific policies.

Does CPT 96130 need to be performed on the same day as 96136 or 96138?

No. CPT 96130 evaluation services may be performed on a separate day from CPT 96136 (test administration by a provider) or CPT 96138 (test administration by a technician).

What CPT codes cannot be billed alongside 96130?

Do not bill 96130 alongside 96127 (brief behavioral assessment), 99406–99409 (smoking cessation), 90791 or 90792 (psychiatric diagnostic evaluations), or any psychotherapy codes.

Do I need to be a psychiatrist or psychologist to bill CPT 96130?

No. CMS defines a qualified healthcare professional as an individual qualified by education, training, and licensure who performs a professional service within their scope of practice. Any physician or QHP meeting this definition may bill 96130 — there is no specialty restriction. Individual payer credentialing requirements may vary.

Can I bill CPT 96130 with telemedicine?

Yes. As of January 2026, CMS has approved CPT 96130 for use with telemedicine through December 31, 2026.