Psychological testing uses four primary codes: CPT 96130 (clinical psychological testing, first hour of evaluation and interpretation), 96131 (each additional hour), 96136 (administration and scoring, first 30 min), 96137 (each additional 30 min). Neuropsychological testing uses 96132/96133 for evaluation hours plus the same admin codes. Most comprehensive batteries run 3-5 hours and bill as 96130 × 1 + 96131 × 2 to 96131 × 4. Prior authorization is required by the majority of payers. Medicare requires medical necessity justification with a specific mental health diagnosis.
Bill 96130 once per testing episode (first hour), then 96131 for each additional 60-minute block. For administration, bill 96136 for the first 30 minutes, then 96137 for each additional 30-minute block. Do not bill evaluation and administration codes on the same day unless both services are provided. If only administration occurs (technician-only), bill 96136/96137. If only interpretation occurs (remote evaluation), bill 96130/96131. Use the patient's primary mental health diagnosis as the ICD-10 code (e.g., major depression F32.9, ADHD F90.9, cognitive impairment R48). Do not bill psychological testing during the same session as a psychotherapy code.
Prior auth is required by 85% of payers. Submit the referral, specific diagnosis, clinical question (e.g., "Rule out ADHD vs. learning disability"), and testing plan. Medicare approves testing when medically necessary. Some payers limit testing to once per 3 years; others restrict to certain diagnoses. Denials often cite "insufficient documentation" of medical necessity. Always attach the referral and a brief summary of why testing is needed. Neuropsychological testing for dementia screening has better coverage than ADHD testing. Verify coverage limits before booking the patient.
Do not bundle psychological testing into general psychiatric E/M visits. If a patient presents for both testing and a medication management visit, bill them on different days or use modifier 25 on the E/M code to indicate a distinct service. When psychologists and psychometrists work on the same case, bill both the evaluation (96130/96131) and administration (96136/96137) on the same claim—they are not bundled. Do not use modifiers with testing codes.
Document the referral reason, specific diagnosis, and clinical question (e.g., "Assess for ADHD," "Evaluate cognitive decline"). List all tests administered by name and time spent. Record raw scores, standard scores, and interpretation. Include a narrative summary linking test results to the referral question and treatment recommendations. For Medicare claims, clearly state why testing was medically necessary. Retain all raw test data per your state's psychology licensing board rules (typically 7-10 years). Provide a detailed report to the referring provider.
ADHD, depression, anxiety, cognitive impairment, personality disorders, and suspected dementia generally qualify. Learning disabilities in children also qualify. Avoid diagnoses like "adjustment disorder" or "maladaptive behavior"—payers view these as insufficient medical necessity. Use the most specific diagnosis supported by your clinical evaluation.
Most comprehensive batteries (WISC, WAIS, MMPI-2, etc.) run 3-5 hours. Shorter screenings (10-30 min) may not justify billing as they often represent symptom checklists, not full testing. Check your payer's guidelines on minimum testing time. Document actual time spent.
Supervised remote testing is allowed for evaluation (96130/96131) but not for administration requiring in-person observation. If a psychometrist administers in-person while the psychologist interprets remotely, bill both services. Check your payer's specific telehealth testing policy.
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