CPT 96138: Billing Guide & FAQ (2026)

CPT 96138 is the billing code for psychological or neuropsychological test administration and scoring performed by a technician under the supervision of a physician or qualified healthcare professional. As of January 2026, the Medicare national average reimbursement is $37.73 for the first 30 minutes. This code allows a physician or qualified healthcare professional to bill for test administration performed by a technician, trained clinical staff working under their supervision — a workflow that increases testing capacity by freeing the provider to focus on evaluation and clinical decision-making.

Understanding 96138 is essential for physicians who use technicians to administer psychological tests under their supervision. The code captures the same work as 96136 but at a lower rate, reflecting that a technician — not the provider — performs the hands-on administration. Below is a comprehensive guide covering eligibility, supervision requirements, time rules, and the most common billing questions.

What is CPT 96138?

96138 is defined as: “Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes.”

This code covers the first 30 minutes of test administration and scoring when performed by a technician under physician supervision. It requires two or more tests administered by any method — paper, verbal, or electronic. Like 96136, it is part of the psychological testing code family introduced by CMS in 2019.

Who Can Bill 96138?

The billing provider is the supervising physician or qualified healthcare professional, not the technician. 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.

The technician performs the test administration, but the claim is submitted under the supervising provider’s credentials.

Who cannot bill 96138: Therapists and Licensed Social Workers generally cannot bill 96138 under CMS guidelines. The billing provider must be a physician or QHP who supervises the technician’s work. Check your state’s scope-of-practice rules and payer policies for specific eligibility requirements.

Who can serve as a technician: Anyone trained to administer psychological testing who works under the supervision of a physician or qualified healthcare professional. Specific credentialing requirements vary by state scope-of-practice rules and individual payer policies.

2026 Reimbursement Rates

Payer Type	Rate (First 30 min)	Additional 30 min (96139)
Medicare (national avg.)	$37.73	Check Medicare fee schedule
Commercial	Varies by payer and contract	Varies
Medicaid	Varies by state	Varies by state

CPT 96138 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 96138 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 by the technician
• 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 96138

If test administration time exceeds 30 minutes, bill each additional 30 minutes using CPT 96139. For example, if a technician’s test administration takes 1.5 hours total, bill 96138 (first 30 minutes) plus 96139 with 2 units (minutes 31–90).

96138 vs. 96136: Technician vs. Provider Administration

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

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

The sole difference is who performs the test administration. Using the wrong code is a common billing error — ensure your documentation clearly identifies whether a technician or provider administered the tests.

When to use 96138 vs. 96136: If your workflow involves a technician administering tests (e.g., handing a patient a tablet with Connected Mind, which administers and scores automatically) while the provider handles other patients, that is 96138. If the provider personally sits with the patient and administers the tests, that is 96136.

ICD-10 Codes for 96138

Medicare requires mental health-related ICD-10 codes for 96138 — 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 96138, or the payer may consider 96138 bundled with the E&M and deny payment. Use distinct condition codes for each service.

Modifier Rules

When billing 96138 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 96138 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 96138 Fits the Testing Workflow

The psychological testing codes work as a three-stage system — and 96138 is often the most practical choice for high-volume practices:

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

Example workflow:

• Visit 1: Screening results indicate further testing is needed. Administer comprehensive tests under provider supervision (96138).
• Visit 1 or follow-up visit: Provider reviews results, integrates clinical data, creates treatment plan, and provides feedback to patient (96130).

Testing and evaluation do not need to occur on the same day.

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 96138. Administering only a PHQ-9 and GAD-7, for example, should be billed using 96127 or 96146 — not 96138. 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 96138 for use with telemedicine through December 31, 2026. This enables remote test administration workflows where a technician administers electronic assessments to a patient remotely under provider supervision.

Codes That Cannot Be Billed With 96138

Do not bill 96138 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 96138.

Documentation Requirements

To support 96138 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 a technician (not the provider) performed the work
• Who supervised — the billing provider’s name and credentials
• 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

How Connected Mind Supports 96138 Billing

Connected Mind® with Fast Check® tests for up to six mental health conditions with validated scores and results.

• See how Connected Mind works
• View pricing for your practice
• Request a demo

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 96136 FAQ — Test administration by a provider
• 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 96138?

CPT 96138 is the billing code for psychological or neuropsychological test administration and scoring by a technician, covering two or more tests by any method, for the first 30 minutes.

How much does CPT 96138 pay in 2026?

As of January 2026, the Medicare national average reimbursement for CPT 96138 is $37.73 for the first 30 minutes. Commercial payer rates vary but are typically higher than Medicare.

Who can bill CPT 96138?

The supervising physician or qualified healthcare professional bills 96138 on behalf of the technician. 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 and Social Workers generally cannot bill 96138 under CMS guidelines. Check your state's scope-of-practice rules for specific eligibility.

Can a technician bill CPT 96138 directly?

No. The technician performs the test administration, but the billing is submitted by the supervising physician or qualified healthcare professional. The provider is responsible for overseeing the technician's work.

What is the difference between CPT 96138 and CPT 96136?

The difference is who administers the tests. CPT 96138 is for test administration by a technician under provider supervision. CPT 96136 is for test administration by a physician or qualified healthcare professional directly. 96136 pays more ($43.94 vs. $37.73 Medicare) because the provider performs the work personally.

Is CPT 96138 time-based?

Yes. CPT 96138 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 96138 test administration time exceeds 30 minutes?

If test administration time exceeds 30 minutes, bill each additional 30 minutes using CPT 96139. For example, if test administration takes 1.5 hours, bill 96138 for the first 30 minutes and 96139 with 2 units for the remaining time.

Which ICD-10 codes can I use with CPT 96138?

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 96138, or the payer may consider 96138 bundled and deny payment.

What modifier should I use when billing CPT 96138?

When billing 96138 with an E&M code, bill the E&M code first with modifier 25 (significant, separately identifiable E&M service). Bill 96138 last with modifier 59 (distinct procedural service).

How many times per year can I bill CPT 96138?

CPT 96138 may be billed as often as medically necessary. While the MUE does not restrict annual frequency, some individual payers may limit how often 96138 can be billed per year. Check with each payer for their specific policies.

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

No. CPT 96138 test administration services may be performed on a separate day from CPT 96130 evaluation services.

What CPT codes cannot be billed alongside 96138?

Do not bill 96138 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 96138?

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 supervise and bill 96138 — there is no specialty restriction. Individual payer credentialing requirements may vary.

Can I bill CPT 96138 with telemedicine?

Yes. As of January 2026, CMS has approved CPT 96138 for use with telemedicine through December 31, 2026.