CPT 96136: Billing Guide & FAQ (2026)

CPT 96136 is the billing code for psychological or neuropsychological test administration and scoring performed by a physician or other qualified healthcare professional. As of January 2026, the Medicare national average reimbursement is $43.94 for the first 30 minutes. This code captures the hands-on work of administering and scoring two or more validated tests — the step between initial screening and clinical evaluation.

The critical distinction with 96136 is who performs the work: it applies only when a physician, mid-level, or qualified healthcare professional personally administers the tests. When a technician administers the same tests under supervision, the correct code is 96138. Below is a comprehensive guide covering eligibility, time requirements, reimbursement rates, and the most common billing questions.

What is CPT 96136?

96136 is defined as: “Psychological or neuropsychological test administration and scoring by physician or other qualified healthcare professional, two or more tests, any method; first 30 minutes.”

This code covers the first 30 minutes of test administration and scoring when performed directly by a provider. It requires two or more tests administered by any method — paper, verbal, or electronic. The code is part of the psychological testing code family introduced by CMS in 2019.

Who Can Bill 96136?

Any physician, mid-level, or qualified healthcare professional who personally administers and scores the tests may bill 96136. 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 96136: Therapists, Licensed Social Workers, and technicians generally cannot bill 96136 under CMS guidelines. If a technician performs the test administration, use CPT 96138 instead. Check your state’s scope-of-practice rules and payer policies for specific eligibility requirements.

2026 Reimbursement Rates

Payer Type	Rate (First 30 min)	Additional 30 min (96137)
Medicare (national avg.)	$43.94	Check Medicare fee schedule
Commercial	Varies by payer and contract	Varies
Medicaid	Varies by state	Varies by state

CPT 96136 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 96136 is a time-based code covering the first 30 minutes of test administration and scoring. The key rules:

• Minimum time: 16 minutes of total time (half the defined 30 minutes plus one minute)
• Total time, not face time: The clock includes all administration and scoring activities
• What counts: Administering tests to the patient (by any method), scoring completed tests, and related documentation
• Two or more tests required: A single test alone does not qualify for 96136

If test administration time exceeds 30 minutes, bill each additional 30 minutes using CPT 96137. For example, if test administration takes 1.5 hours total, bill 96136 (first 30 minutes) plus 96137 with 2 units (minutes 31–90).

96136 vs. 96138: Provider vs. Technician Administration

This is the most important distinction in the test administration codes:

CPT 96136 — Provider Administration

• Who administers: Physician or QHP directly
• 2026 Medicare rate: $43.94 (first 30 min)
• Add-on code: 96137 (each additional 30 min)
• Minimum time: 16 minutes

CPT 96138 — Technician Administration

• Who administers: Technician under provider supervision
• 2026 Medicare rate: $37.73 (first 30 min)
• Add-on code: 96139 (each additional 30 min)
• Minimum time: 16 minutes

Both codes require two or more tests and both can use any administration method. The sole difference is who performs the work. Using the wrong code is a common billing error — ensure your documentation clearly identifies whether the provider or a technician administered the tests.

ICD-10 Codes for 96136

Medicare requires mental health-related ICD-10 codes for 96136 — 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.

Critical rule: Do not use the same ICD-10 codes to justify both your E&M service and 96136, or the payer may consider 96136 bundled with the E&M and deny payment. Use distinct condition codes for each service.

Modifier Rules

When billing 96136 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 96136 last with modifier 59 (distinct procedural service)

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

How 96136 Fits the Testing Workflow

The psychological testing codes work as a three-stage system:

1. Screening — 96127: Brief behavioral assessment to identify patients who need further testing
2. Test Administration — 96136 (provider) or 96138 (technician): Administering and scoring comprehensive tests
3. Evaluation — 96130: Interpreting results, clinical decision making, treatment planning, and feedback

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

Important CMS update (July 2020): CMS guidelines no longer allow testing comprised solely of brief symptom inventories or screening tests to qualify as comprehensive psychological testing under 96136. Administering only a PHQ-9 and GAD-7, for example, should be billed using 96127 or 96146 — not 96136. The tests must be standardized instruments that constitute comprehensive psychological or neuropsychological testing. Refer to the CMS billing and coding articles for specific requirements.

Telemedicine Billing

As of January 2026, CMS has approved CPT 96136 for use with telemedicine through December 31, 2026. Providers conducting virtual test administration sessions can bill 96136 with the appropriate telehealth modifier.

Codes That Cannot Be Billed With 96136

Do not bill 96136 on the same date of service as:

• 96127 (brief emotional/behavioral assessment)
• 99406–99409 (smoking/tobacco cessation counseling)
• 90791 (psychiatric evaluation)
• 90792 (psychiatric 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 test administration captured by 96136.

Documentation Requirements

To support 96136 claims, maintain records showing:

• Which tests were administered (must be two or more)
• Administration method (paper, verbal, electronic)
• Who administered the tests — must clearly document that the provider (not a technician) performed the work
• Total time spent on administration and scoring (minimum 16 minutes)
• Scores obtained for each test
• Medical necessity — why comprehensive testing was indicated beyond brief screening

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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 96130 FAQ — Psychological testing evaluation services
• 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 96136?

CPT 96136 is the billing code for psychological or neuropsychological test administration and scoring by a physician or other qualified healthcare professional, covering two or more tests by any method, for the first 30 minutes.

How much does CPT 96136 pay in 2026?

As of January 2026, the Medicare national average reimbursement for CPT 96136 is $43.94 for the first 30 minutes. Commercial payer rates vary but are typically higher than Medicare.

Who can bill CPT 96136?

Any physician or qualified healthcare professional may bill 96136. 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, Social Workers, and technicians generally cannot bill 96136 under CMS guidelines. Individual payer credentialing requirements may vary.

Can the work for CPT 96136 be delegated to a technician?

No. CPT 96136 is specifically for test administration performed by a physician or qualified healthcare professional. If a technician performs the test administration, use CPT 96138 instead.

What is the difference between CPT 96136 and CPT 96138?

The difference is who administers the tests. CPT 96136 is for test administration by a physician or qualified healthcare professional. CPT 96138 is for test administration by a technician under the supervision of a qualified provider. Both codes cover the first 30 minutes and require two or more tests.

Is CPT 96136 time-based?

Yes. CPT 96136 is a time-based code covering the first 30 minutes of test administration and scoring. A minimum of 16 minutes of total time (not face time) must be spent to bill one unit.

What if CPT 96136 test administration time exceeds 30 minutes?

If test administration time exceeds 30 minutes, bill each additional 30 minutes using CPT 96137. For example, if test administration takes 1.5 hours, bill 96136 for the first 30 minutes and 96137 with 2 units for the remaining time.

Which ICD-10 codes can I use with CPT 96136?

Medicare requires mental health-related ICD-10 codes, generally F-codes or codes for symptoms related to mental health conditions. Do not use the same ICD-10 codes for both your E&M service and 96136, or the payer may consider 96136 bundled and deny payment.

What modifier should I use when billing CPT 96136?

When billing 96136 with an E&M code, bill the E&M code first with modifier 25 (significant, separately identifiable E&M service). Bill 96136 last with modifier 59 (distinct procedural service).

How many times per year can I bill CPT 96136?

CPT 96136 may be billed as often as medically necessary. While the MUE does not restrict annual frequency, some individual payers may limit how often 96136 can be billed per year. Check with each payer for their specific policies.

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

No. CPT 96136 test administration services may be performed on a separate day from CPT 96130 evaluation services. They can also be billed on the same day.

What CPT codes cannot be billed alongside 96136?

Do not bill 96136 alongside 96127 (brief behavioral assessment), 99406–99409 (smoking cessation), 90791 or 90792 (psychiatric evaluations), or any psychotherapy codes.

Do I need to be a psychiatrist or psychologist to bill CPT 96136?

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 96136 — there is no specialty restriction. Individual payer credentialing requirements may vary.

Can I bill CPT 96136 with telemedicine?

Yes. As of January 2026, CMS has approved CPT 96136 for use with telemedicine through December 31, 2026.