As of 2026, psychological testing is billed primarily with CPT codes 96130 (first hour) and 96131 (each additional hour) for psychological evaluation services, and 96132/96133 for neuropsychological evaluations.
Who can bill for 96101?
CPT code 96101 was retired and replaced with 96130 and 96131 for psychological testing evaluation services.
Back in 2021, the AMA updated these codes to match how psychological testing actually works today. Only docs and other qualified healthcare pros—think psychologists or nurse practitioners—can bill these new codes. Licensed clinical social workers and regular therapists? They don’t qualify to use these particular codes.
Who can bill CPT 96130?
This code covers the first hour of psychological testing. You don’t need a behavioral health specialty to use it, but the provider does need to be legally allowed to perform these services under their state’s scope-of-practice rules. For instance, a family doctor or a pediatric nurse practitioner could bill 96130 if they’re actually doing the testing themselves.
Can 96130 and 96131 be billed together?
Code 96130 is billed for the first hour of psychological testing evaluation, and 96131 for each additional hour on the same or different days.
These codes work together when an evaluation takes more than an hour. The billing professional has to do the evaluation before any tests are administered. Medicare and most private insurers accept these add-on codes—as long as you’ve got the right documentation to back it up.
What is the CPT code for psychological testing?
For psychological testing evaluation services, use CPT code 96130 for the first hour and 96131 for each additional hour.
The American Psychological Association says these are the go-to codes for billing psychological testing. If you’re doing neuropsychological evaluations, use 96132 (first hour) and 96133 (each additional hour). Just remember—always double-check the payer’s specific rules before you submit anything.
Who can Bill 96127?
A physician must supervise and bill CPT code 96127, which covers brief emotional/behavioral assessments.
This code is for quick screenings like the PHQ-9. While primary care docs use 96127 all the time, psychiatrists and other mental health pros can use it too—as long as a physician is supervising. The supervising doctor has to document the service and file the report.
What does CPT code 90791 mean?
CPT code 90791 represents an integrated biopsychosocial assessment, including history, mental status, and recommendations.
The AMA rolled out 90791 in 2013 as part of their mental health CPT code updates. It replaced older codes like 90801 and is mostly used for initial psychiatric evaluations. Only licensed mental health providers—psychiatrists, psychologists, or clinical social workers—can use this code.
Who can perform a neuropsychological evaluation?
Technicians may conduct baseline neuropsychological testing under the supervision of a neuropsychologist, while complex post-injury assessments require a clinical neuropsychologist.
According to the American Academy of Clinical Neuropsychology, trained techs can run standardized tests, but only a licensed neuropsychologist can interpret the results and make diagnostic decisions. Always check your state’s licensing rules before performing or billing these services.
What is a category code?
In ICD coding, a category code is the first three characters of the code that describe the injury or disease.
In CPT coding, "Category" refers to how the codes are grouped: Category I (standard procedures), Category II (performance measures), and Category III (emerging tech). Most psychological and neuropsychological testing services fall under Category I codes.
How Much Does Medicare pay for 96116?
As of 2026, Medicare reimburses CPT code 96116 at approximately $110 for the first hour (national average).
That rate can shift a bit depending on where you’re located and which Medicare Administrative Contractor (MAC) handles your region. For the second hour, code 96121 reimburses around $92. Check the Medicare Physician Fee Schedule for the latest rates in your area.
| CPT Code | Description | 2026 Medicare Reimbursement (National Average) |
|---|
| 96116 | Neurobehavioral status exam, first hour | $109.85 |
| 96121 | Neurobehavioral status exam, additional hour | $91.95 |
What does CPT code 90792 mean?
CPT code 90792 represents a psychiatric diagnostic interview examination (PDE), including a full medical and psychiatric history and mental status exam.
This code is for in-depth initial evaluations by licensed mental health providers. It covers gathering a complete psychiatric history, doing a mental status exam, and coming up with a differential diagnosis. Don’t mix this up with 90791—that one’s a more focused biopsychosocial assessment.
What are the new CPT codes for 2021?
In 2021, new CPT codes 33995 and 33997, and revised codes 33990–33993 were introduced for ventricular assist device (VAD) procedures.
These changes reflect updates in cardiac device tech and coding practices. They don’t have anything to do with psychological testing, but they’re part of the AMA’s annual CPT updates. Always review the latest AMA CPT updates to stay current.
What does CPT codes stand for?
CPT codes stand for Current Procedural Terminology, a standardized system of codes and terms for medical procedures.
The American Medical Association publishes these codes, which are used for billing, medical records, and statistical reporting. The first edition came out way back in 1966, and the system gets updated every year to keep up with new procedures and tech.
How many times a year can you bill 96127?
Most insurance plans allow billing CPT code 96127 up to 4 times per year, with up to 2 units per visit.
Medicare and many private insurers follow this limit, but some plans might be stricter. Always check the patient’s specific coverage and authorization rules before submitting claims. And make sure your documentation clearly shows why each administration was medically necessary.
Do you need modifier 25 with 96127?
Modifier 25 is not required for CPT code 96127 when billed with an evaluation and management (E/M) service on the same day.
The CMS National Correct Coding Initiative says there’s no conflict between 96127 and modifier 25. That said, some commercial payers might have their own rules, so always check their guidelines before billing.
How much does it cost to bill a 96127?
As of 2026, the average fee for CPT code 96127 is approximately $27 per administration.
The actual cost can vary depending on the provider type, where you’re located, and your payer contracts. Medicare reimburses around $22 per unit, while private insurers might pay anywhere from $25 to $40. If you’re doing a lot of these, consider using billing software to streamline submissions and cut down on errors.
Edited and fact-checked by the FixAnswer editorial team.
