Psychological Testing Benefits

Psychological testing or neuropsychological testing can be performed in an inpatient or outpatient setting.  (See also: Medical Necessity and Level of Care)

Claims Filing Instructions for Time Units

For all HMSA plans, including QUEST Integration and Akamai Advantage®, providers should bill the units for psychological testing as described by the CPT code being billed: The service date indicated on the claim form must reflect the date that the testing was performed, regardless if the report was completed at a later date.

The following are samples of time based codes for psychological testing evaluation services. The codes are billed in time units based on the number of hours spent interpreting and reporting the results.

96130

Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour.

96131

Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; each additional hour (List separately in addition to code for primary procedure.)

The following are samples of time based codes for psychological or neuropsychological testing and scoring. The codes are billed in time units based on the number of each 30 minutes spent interpreting and reporting the results.

96136

Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes.

96137

Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; each additional 30 minutes (List separately in addition to code for primary procedure.) 

96138 

Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes.

96139

Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; each additional 30 minutes (List separately in addition to code for primary procedure.) 

Example Scenario: The psychologist conducts a comprehensive assessment including 2 hours of testing evaluation, 4 hours of testing administration and scoring, and 2 hours of interpretation and report. The provider should bill for 1 hour under 96130, 3 hours under 96131, 30 minutes under 96136, and 1 and half hours under 96137.

The following flat rate code is not time based (only 1 unit should be billed):

96146

Psychological or neuropsychological test administration, with single automated, standardized instrument via electronic platform, with automated result only.

Revision History