Psychological testing in 2026 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 in 2019 and replaced with 96130 and 96131 for psychological testing evaluation services.
The AMA retired 96101 to better reflect current practice patterns where psychologists and physicians personally administer and interpret tests. Only qualified healthcare professionals — physicians, clinical psychologists, and in some states nurse practitioners or physician assistants — may bill the replacement codes. Licensed clinical social workers and master's-level therapists can't bill 96130/96131 under Medicare rules. Verify your state scope-of-practice laws before submitting claims.
Who can bill CPT 96130?
A physician or other qualified healthcare professional (QHP) such as a licensed clinical psychologist or nurse practitioner may bill CPT 96130 for the first hour of psychological testing evaluation.
The provider has to personally administer the tests and interpret results — technicians can't perform the service "incident to" for this code. Medicare defines QHPs as those legally authorized to perform the service under state law. A primary care physician or pediatrician can bill 96130 if they conduct the evaluation themselves. Document the clinical rationale, tests administered, interpretation, and time spent to support medical necessity.
Can 96130 and 96131 be billed together?
Yes, 96130 (first hour) and 96131 (each additional hour) are billed together when a psychological testing evaluation exceeds 60 minutes.
Report 96130 once per day and 96131 for each additional hour or fraction thereof beyond the first hour. The codes can span multiple dates if the evaluation isn't completed in one session. Medicare and most commercial payers require the evaluation to occur before test administration. Maintain detailed time logs showing start/stop times for each session to defend against audits.
What is the CPT code for psychological testing?
For psychological testing evaluation, use CPT 96130 (first hour) and 96131 (each additional hour); for neuropsychological testing, use 96132 (first hour) and 96133 (each additional hour).
The American Psychological Association confirms these four codes replaced the old 96101–96103 series in 2019. Choose the code set based on whether the service is psychological (96130/96131) or neuropsychological (96132/96133) — the distinction hinges on test complexity and clinical purpose. Always verify payer-specific coverage policies before billing, as some plans limit frequency or require prior authorization.
Who can Bill 96127?
A physician must supervise and bill CPT 96127 for brief emotional/behavioral assessments such as the PHQ-9 or GAD-7.
While the screening itself can be administered by clinical staff, the supervising physician (MD/DO) must document medical necessity, review results, and include findings in the treatment plan. Psychiatrists, primary care physicians, and other physicians can bill 96127. Non-physician practitioners (NPs, PAs) may bill under their own NPI if state law permits independent practice. The service is typically limited to once per date of service per patient.
What does CPT code 90791 mean?
CPT 90791 represents an integrated biopsychosocial assessment including history, mental status exam, and treatment recommendations — commonly used for initial psychiatric diagnostic evaluations.
Introduced in 2013, 90791 replaced 90801 and covers a comprehensive evaluation without medical services (no medication management). Licensed mental health providers — psychiatrists, psychologists, clinical social workers, and licensed professional counselors — may bill this code. It typically reimburses higher than 90792 because it excludes medical work. Document presenting problem, history, mental status, diagnosis, and treatment plan to support the claim.
Who can perform a neuropsychological evaluation?
Trained technicians may administer standardized neuropsychological tests under a neuropsychologist's supervision, but only a licensed clinical neuropsychologist can interpret results and render diagnostic conclusions.
The American Academy of Clinical Neuropsychology states that test administration by technicians is acceptable when the neuropsychologist selects tests, supervises administration, and personally interprets data. Complex post-injury or dementia evaluations require the neuropsychologist's direct involvement throughout. Check your state psychology board rules — some prohibit technician use entirely. Bill 96132/96133 for the neuropsychologist's interpretation time, not technician time.
What is a category code?
In CPT coding, "Category" refers to code classification: Category I (standard procedures/services), Category II (performance measurement), and Category III (emerging technology).
Psychological testing codes 96130–96133 are Category I codes — established, FDA-cleared (where applicable), and widely covered. Category II codes (e.g., 1000F–9999F) track quality measures and have $0 reimbursement. Category III codes are temporary for new services; they convert to Category I after 5 years if adopted. In ICD-10-CM, "category" means the first three characters (e.g., F32 for major depressive disorder). Don't confuse the two systems.
How Much Does Medicare pay for 96116?
As of 2026, Medicare's national average reimbursement for CPT 96116 (neurobehavioral status exam, first hour) is approximately $110, with 96121 (each additional hour) at roughly $92.
Actual payment varies by Geographic Practice Cost Index (GPCI) — a provider in San Francisco may receive $135 while one in rural Mississippi gets $95. The Centers for Medicare & Medicaid Services publishes final rates each November for the following calendar year. Check your Medicare Administrative Contractor's (MAC) fee schedule for your locality. These rates apply to facility and non-facility settings differently; non-facility rates are typically higher.
| CPT Code | Description | 2026 Medicare Reimbursement (National Average) |
|---|
| 96116 | Neurobehavioral status exam, first hour | $110 |
| 96121 | Neurobehavioral status exam, each additional hour | $92 |
| 96130 | Psychological testing evaluation, first hour | $118 |
| 96131 | Psychological testing evaluation, each additional hour | $95 |
| 96132 | Neuropsychological testing evaluation, first hour | $125 |
| 96133 | Neuropsychological testing evaluation, each additional hour | $102 |
What does CPT code 90792 mean?
CPT 90792 is a psychiatric diagnostic evaluation with medical services, including history, mental status, and medication management — used when the provider prescribes or manages psychotropic medications.
Unlike 90791 (no medical services), 90792 requires a physician or advanced practice provider with prescribing authority. Psychiatrists, psychiatric NPs, and PAs typically bill this code for initial evaluations that include medication decisions. Medicare reimburses 90792 slightly lower than 90791 because the medical component is valued separately. Document medication review, lab orders, and prescription rationale to justify the medical service component.
What are the new CPT codes for 2021?
For psychological testing, the key 2021 CPT changes were the addition of 96130–96133 (replacing 96101–96103) and revisions to health behavior assessment codes 96156–96159.
The AMA also introduced new codes for remote therapeutic monitoring (98975–98980) and updated telehealth modifiers. For mental health, 90785 (interactive complexity) became an add-on to 90791/90792/90832–90838. The CPT code set updates annually each January; always use the current year's codebook. Subscribe to AMA CPT updates or check your specialty society's coding alerts to stay current.
What does CPT codes stand for?
CPT stands for Current Procedural Terminology — a standardized code set maintained by the American Medical Association to describe medical, surgical, and diagnostic services for billing and data tracking.
CPT codes are five-character alphanumeric identifiers (e.g., 96130) used universally on CMS-1500 claim forms. They differ from ICD-10-CM diagnosis codes (which describe the patient's condition) and HCPCS Level II codes (for supplies, equipment, and non-physician services). The AMA updates CPT annually; using outdated codes triggers claim denials. Most EHR systems auto-update, but verify your software reflects the current year's changes before January 1.
How many times a year can you bill 96127?
Medicare allows billing 96127 up to twice per calendar year per patient for depression screening (G0444), but commercial payer limits vary — some allow quarterly, others only annually.
Medicare's preventive service G0444 (depression screening) covers one annual screening; 96127 can be used for additional brief assessments when clinically indicated. Document medical necessity for each administration — routine screening without symptoms may be denied. Check your specific payer's policy: Blue Cross plans often follow Medicare, while Medicaid varies by state. Track frequency in your EHR to avoid accidental overbilling.
Do you need modifier 25 with 96127?
Modifier 25 (significant, separately identifiable E/M service) is required when billing 96127 on the same day as an E/M visit (e.g., 99213) to show the screening was distinct from the office visit.
Without modifier 25, payers may bundle 96127 into the E/M payment. The E/M service must address a separate problem or be substantially beyond the screening. For example, a patient presents for diabetes follow-up (99213) and completes a PHQ-9 (96127) — append modifier 25 to the E/M code. Some payers also accept modifier 59 on 96127 instead; verify your payer's preference. Never use modifier 25 if the visit was solely for the screening.
How much does it cost to bill a 96127?
The 2026 Medicare national average reimbursement for 96127 is approximately $5–$7 per administration, but your practice's cost to bill it (staff time, EHR documentation, claim submission) typically ranges from $15–$30 per claim.
Revenue per unit is low because 96127 is a brief service (5–15 minutes). The real cost is administrative: clinical staff time to administer/score, provider time to review/document, and billing overhead. Many practices absorb the cost as part of comprehensive care rather than billing separately. If you bill high volume, negotiate a carve-out with payers or use value-based care codes (e.g., G0511 for FQHCs) that bundle behavioral health integration. Always run a cost-benefit analysis before adding 96127 to your workflow.
