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CPT Code 96130: Psychological Testing Evaluation Services by a Professional

Learn about CPT Code 96130, its description, documentation requirements, and billing guidelines through this guide!

Table of content

96130 CPT code description CPT code 96130 documentation requirements CPT code 96130 billing process

96130 CPT code description

CPT code 96130 is one of the CPT codes you can use under the Psychological Testing Evaluation Services category by a Professional. By professional, it means a physician or other qualified healthcare professional.

This CPT code covers the integration of patient data (including patient data interpretation), interpreting standardized test results and clinical data (like determining potential mental health conditions a patient might have), clinical decision-making (determining medical necessity), treatment planning and reporting, and interactive feedback with the patient or the patient's family members or caregiver(s).

Any or all of these should have been performed during the first hour of service.

Please note that this doesn't include test administration and scoring. For that, you'll need to use CPT code 96136, which is for psychological and neuropsychological testing evaluation services conducted by a professional, specifically psychological or neuropsychological test administration and scoring of standardized tests.

CPT code 96130 documentation requirements

For providers to qualify using this CPT code for medical billing, a minimum of 31 minutes during the provided service should be documented. This can be 31 minutes of the preparation time before the patient visits, or 31 minutes of the face-to-face time with the patient.

What should be documented are the psychological testing services mentioned in the previous section, clinical reporting, the content of traditional medication review, an indication that the patient has reviewed the testing results as well as the summary of pertinent findings, and the time in and out of the session.

CPT code 96130 billing process

Physicians and their assistants, nurse practitioners, counselors, and psychologists at the master's and doctoral levels are eligible clinicians who can use this code.

This code must be billed as an add-on to the following E/M codes: 99202-99205 for new patients, or 99212-99215 for existing patients.

Commonly asked questions

What do I do if my session exceeds 1 hour? Do I use another code?

You must use CPT code 96131, which is meant to represent each additional hour beyond the first hour. Use it as an add-on to 96130.

Does this code require prior authorization from an insurance provider?

Most of the time, PPOs don't require prior authorization. HMOs might require them because there might be a chance they're not accustomed to the code. It's best to contact the insurance provider to check if they require prior authorization for this.

Since I can't bill two time-based codes in one claim, what do I do with the E/M codes?

It would be best to bill the E/M code as medical decision-making to use 96131 in the same billing.