Comprehensive Guide to Psychological Testing CPT Codes

In mental health care, where comorbidities and misdiagnosis are common, precision in diagnosis and treatment planning is critical. Psychological testing plays a vital role in assessing cognitive, emotional, and behavioral conditions. For healthcare providers, accurate billing and reimbursement for these services hinge on the correct use of Current Procedural Terminology (CPT) codes. 

What are CPT codes for psychological testing?

CPT codes are standardized numerical codes assigned to various medical procedures, including psychological testing, to facilitate billing. For mental health providers, knowing which CPT code to use can be challenging, especially given the overlap with neuropsychological testing. Below is an overview of key psychological testing CPT codes that clinicians should be familiar with, along with approximate reimbursement rates based on 2024 Medicare rates.

Key CPT codes for psychological testing and their reimbursement rates:

96130 – Psychological testing evaluation services (first 60 minutes)

• Description: This code is used when a licensed psychologist or other qualified healthcare provider performs psychological evaluation services, including the interpretation of test results, integration of clinical data, and preparation of a report.
• Reimbursement Rate: Approximately $125-$145 for the first hour of evaluation.

96131 – Psychological testing evaluation services (each additional 60 minutes)

• Description: This add-on code is used for every additional hour of psychological testing and evaluation beyond the first 60 minutes covered by 96130.
• Reimbursement Rate: Approximately $100-$120 per additional hour.

96136 – Psychological or neuropsychological test administration and scoring by a physician or qualified healthcare professional (first 30 minutes)

• Description: This code covers test administration and scoring done by a licensed clinician for the first 30 minutes of testing.
• Reimbursement Rate: Approximately $65-$75 for the first 30 minutes.

96137 – Psychological or neuropsychological test administration and scoring by a physician or qualified healthcare professional (each additional 30 minutes)

• Description: This is the companion code to 96136, used for each additional half-hour of testing beyond the initial 30 minutes.
• Reimbursement rate: Approximately $55-$65 per additional 30 minutes.

96138 – Psychological or neuropsychological test administration and scoring by a technician (first 30 minutes)

• Description: For tests that can be administered and scored by a technician under the supervision of a licensed professional, CPT code 96138 is applicable.
• Reimbursement rate: Approximately $35-$45 for the first 30 minutes of technician-administered testing.

96139 – Psychological or neuropsychological test administration and scoring by a technician (each additional 30 minutes)

• Description: Like 96137, this add-on code is used for every additional 30 minutes of testing conducted by a technician.
• Reimbursement rate: Approximately $30-$40 per additional 30 minutes.

Choosing the right CPT code

Correctly selecting the appropriate CPT code for psychological testing depends on a few factors:

• Who performs the testing: Whether the testing is done by a licensed psychologist, another qualified healthcare professional, or a technician will influence the choice of code.
• Duration of the service: Different codes apply depending on the length of time spent on test administration, scoring, and evaluation. For example, 96130 is for the first hour of evaluation, while 96131 applies for additional hours.
• Type of testing: Psychological and neuropsychological tests often overlap in their administration. However, providers need to carefully distinguish between them to avoid billing errors.

Avoiding common mistakes

• Improper use of time-based codes: Many of these CPT codes are time-based, meaning it's essential to track the exact time spent on testing and evaluation. Inaccuracies in documenting time can lead to claim denials or overbilling.
• Misclassification of personnel: Ensure that the right code is used based on whether the testing is administered by a clinician or a technician. Technicians can use the 96138 and 96139 codes, but clinician-administered tests require 96136 or 96137.

Which code can I use for MindMetrix?

• 96130 – Psychological Testing Evaluation Services (First 60 minutes)

Why accurate billing matters

Accurate CPT coding and understanding reimbursement rates ensure that mental health providers receive appropriate payment for their services. Proper coding minimizes the risk of audits, claim denials, or underpayment, streamlining the billing process for both providers and payers.

For mental health professionals, mastering the nuances of psychological testing CPT codes and knowing the associated reimbursement rates is an essential aspect of practice management. With proper coding, clinicians can focus more on delivering quality care to their patients and less on administrative burdens.

Sources

1. Graham, M. (2023, June 30). Psychological testing: Common CPT codes and best practices for submitting claims. Gentem.