Mastering CPT Code 96130

A guide to psychological testing review reimbursement

Navigating the intricacies of medical billing can be daunting, but understanding specific CPT codes and their appropriate usage is essential to getting reimbursed for the full value of your services. One such code, 96130, covers psychological testing evaluation services, including your time spent on interpretation and reporting of tools like MindMetrix.

This guide outlines what 96130 covers, who can bill for it, and how to maximize your reimbursement with clear documentation and workflow tips.

What is CPT Code 96130?

CPT code 96130 refers to the first hour of psychological testing evaluation, review and interpretation, performed by a physician or other qualified healthcare professional. It is a time-based code, requiring a minimum of 31 minutes, and can include both face-to-face and non-face-to-face time.

96130 includes:

• Reviewing test results (e.g., from MindMetrix)

• Integrating patient data and collateral information

• Interpreting standardized test scores

• Clinical decision-making

• Treatment planning

• Documentation and report writing

• Feedback to the patient and/or caregiver(s)

✅ Note: Combined visit prep time and time spent face-to-face with the patient count towards the 31-minute minimum. 

Who can bill for 96130?

96130 can typically be billed by:

• Physicians (MD, DO)
• Nurse Practitioners (NP)
• Physician Assistants (PA)
• Licensed Psychologists and Doctoral-Level Clinicians
• Master’s-Level Clinicians (depending on payer contract)

Reimbursement ranges

Most major insurances will reimburse 96130 for MDs, NPs, PAs, PhDs, including Medicare, for MDs, NPs, PAs, PhDs. Optum plans may only reimburse 96130 for PhDs, but it is always best to check your contract.

Reported reimbursement ranges are typically between $113–$175 per unit, though this varies by payer, provider type, and contract. These amounts are subject to co-pays, co-insurance and deductibles.

To understand your practice’s expected reimbursement:

1. Review your fee schedules to confirm that 96130 is covered.
2. Check your contract to see which provider types are authorized to bill the code.
3. Note any carve-outs or rate differences by provider credentials.
4. Understand whether there are any state-specific “scope of practice” limitations that apply to you.

Billing scenarios and documentation tips

Prescribing clinicians (MDs, NPs, PAs):

When reviewing psychological testing results during an intake or med review:

• Bill both 96130 AND appropriate CPT for your visit (e.g., 99202–99205 for new patients; 99212–99215 for established patients) on the same claim.
• E/M selection should be based on medical decision-making, not time, since 96130 is a time-based code (only one code per visit can be time-based)
• For the 96130 portion of your note, document:
  • Summary of the psychological findings
  • Time in/out for the 96130 portion
  • Total time ≥31 minutes (includes prep + face-to-face)

🔧 Use tools like the QuickChart Template (available in MindMetrix) to automatically generate chart notes that include the information above and calculate time spent.

Best practices for 96130 success

• Mental health diagnosis codes (F codes) should be used to support medical necessity.
• When billing 96130 with an E/M service, code E/M based on medical decision-making, not time
• Use modifiers correctly:
  • Add modifier 59 to 96130 to denote a distinct service when included with another.
  • Add modifier 95 if the session was conducted via telehealth (after the 59).
  • A 25 modifier may be needed on the E/M code depending on payer guidelines.

An example of how to bill 96130 along with an E/M telehealth visit:

 Another example of what this could look like is here:

Prior authorization

• Typically not required for PPOs.
• May be requested by some HMOs.
• If you encounter unexpected prior auth denials, it’s worth inquiring or disputing, as this may stem from a lack of familiarity with the code.

Non-prescribing clinicians (psychologists, counselors)

• Bill 96130 as a standalone code, replacing the therapy code for that session.
• Document:
  • That test results were reviewed
  • A summary of key findings
  • Any recommendations discussed
  • Session length (≥31 minutes)

 📋 If the session exceeds one hour, add units of 96131 to reflect additional time.

What if 96130 isn’t reimbursed?

• 96127 is a non–time-based alternative that covers brief emotional/behavioral assessments, including scoring and documentation using standardized instruments.
  • Typical reimbursement is $7-$12 per unit
  • Commonly used for ADHD, depression, anxiety, suicide risk, and substance use screening
  • Can be billed for each assessment given, but insurance usually caps it at four units per visit
• E/M codes based on time can be used when 96130 isn’t accepted (e.g., for reviewing testing results during a lengthy medication session).

Billing CPT code 96130 allows clinicians to be reimbursed for the critical work of interpreting psychological assessments and integrating them into care planning. With the right documentation and billing practices, you can maximize your reimbursement while ensuring patients receive data-driven, informed care.

💡Schedule a free appointment with our billing consultant for help submitting a 96130 claim using MindMetrix or for questions about modifiers / documentation. We’re here to support your success.