Psychological testing coverage by payer and state, with sources
The short answerWhat payers publish about psychological testing for psychologists: which of 96130, 96131, 96132 and 96133 and the other codes each policy names, telehealth rules, visit limits and prior authorization, for 25 payers, state Medicaid programs and state laws. Every fact links to its source and the day we checked it.
By Javier Alvarez · Updated · 2 min read
| Rows | 25 payers, Medicaid programs and state laws, each with its own page |
|---|---|
| Codes | 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96116, 96121 and 96146 |
| Sources | 37 official documents, plus 1 secondary source marked unofficial |
25 rows: All payers and states. Public policy, not the member's benefits.
Medicare (national)
Original Medicare Part B, Physician Fee Schedule and Benefit Policy Manual · All states
| 96116 | Listed (neurobehavioral status exam, first hour (active on the 2026 PFS)) [1] |
|---|---|
| 96121 | Listed (add-on, each additional hour (active on the 2026 PFS)) [1] |
| 96130 | Listed (psychological testing evaluation, first hour (active on the 2026 PFS)) [1] |
| 96131 | Listed (add-on, each additional hour (active on the 2026 PFS)) [1] |
| 96132 | Listed (neuropsychological testing evaluation, first hour (active on the 2026 PFS)) [1] |
| 96133 | Listed (add-on, each additional hour (active on the 2026 PFS)) [1] |
| 96136 | Listed (test administration and scoring by the clinician, first 30 minutes (active on the 2026 PFS)) [1] |
| 96137 | Listed (add-on, each additional 30 minutes (active on the 2026 PFS)) [1] |
| 96138 | Listed (test administration and scoring by a technician, first 30 minutes (active on the 2026 PFS)) [1] |
| 96139 | Listed (add-on, technician, each additional 30 minutes (active on the 2026 PFS)) [1] |
| 96146 | Listed (single automated instrument, automated result only (active on the 2026 PFS)) [1] |
| Where it applies | Testing is paid as a diagnostic test under section 1861(s)(3) of the Social Security Act. Incident to billing is not authorized for these tests. Diagnostic testing is outside the outpatient mental health treatment limitation. [2] |
| Telehealth rules | Codes 96116, 96121, 96125, 96130 to 96133 and 96136 to 96139 are on the CY 2026 final list of Medicare telehealth services. We did not find 96146 on that list. Through December 31, 2027, patients can receive Medicare telehealth services anywhere in the United States and territories. [3][4] |
| Who can bill | Clinical psychologists, independently practicing psychologists (with a physician order), NPs, CNSs and PAs within state scope, and physicians. A psychologist on an institution's staff does not bill; the institution does. An independent psychologist who is not a clinical psychologist must put the ordering physician's name and address on the claim. [2] |
| Payment | 2026 national payment computed from the published RVUs times the $33.4009 conversion factor (non-QPP file), non-facility rate: 96130 $123.92, 96131 $86.51, 96132 $122.25, 96133 $97.86, 96136 $43.76, 96137 $37.07, 96138 $37.74, 96139 $35.40, 96146 $2.34. Facility rates for 96130, 96132 and 96136 are $99.53, $98.53 and $21.38. Local rates vary by GPCI. [1] |
| Also | The manual says there is no payment under the fee schedule for services performed by students or trainees. A trainee being present while a licensed clinician tests does not stop the clinician from billing. The manual text still names the pre 2019 code numbers. [2] |
- CMS: CY 2026 Physician Fee Schedule relative value file RVU26D (PPRRVU2026_Oct_nonQPP.csv, conversion factor 33.4009), checked October 30, 2026
- CMS: Medicare Benefit Policy Manual (100-02) Chapter 15, section 80.2 Psychological Tests and Neuropsychological Tests, checked October 30, 2026
- CMS: List of Telehealth Services, CY 2026 PFS final list, checked October 30, 2026
- CMS: Telehealth FAQ (updated 10/8/26), checked October 30, 2026
Medicare, WPS states (IA, IN, KS, MI, MO, NE)
WPS LCD L34646 Psychological and Neuropsychological Testing and billing article A57481 · IA, IN, KS, MI, MO, NE
| 96130 | Not named (evaluation services were removed from the LCD and article in 2020; the LCD addresses testing and scoring only) [1][2] |
|---|---|
| 96132 | Not named (same: evaluation codes 96130 to 96133 were removed from the article's code group) [1] |
| 96136 | Listed (test administration and scoring, clinician) [1] |
| 96137 | Listed (add-on) [1] |
| 96138 | Listed (test administration and scoring, technician under direct supervision) [1] |
| 96139 | Listed (add-on, technician) [1] |
| 96146 | Listed (automated testing and result) [1] |
| Where it applies | The LCD only addresses coverage for psychological and neuropsychological testing and scoring services, not the evaluation services (96130 to 96133). It lists many neuropsychological indications, such as mild or questionable deficits on mental status testing, pre-surgical cognitive evaluation, and cognitive deficits in children and adolescents. [2] |
| Diagnoses | Coverage is not based on diagnosis. The billing article lists no ICD-10 codes and says to report the appropriate diagnosis. Testing is not covered for Alzheimer's disease once a diagnosis has been made. [1] |
| Visit limits | A minimum of 31 minutes must be provided to report any per-hour code. Testing typically takes 4 to 8 hours. If testing runs over several days, combine the time and report it on the last day of service. Above eight hours, the contractor may ask for a report justifying the extra time. [1][2] |
| Who can bill | A provider with an appropriate state license, or a trained technician directly supervised by that provider. Billing needs a Medicare provider number and a license in the state where the service is performed. [2][1] |
| Also | Not reasonable and necessary when used as screening, for educational or vocational purposes that do not establish medical management, for self-administered or self-scored inventories, or when repeated without a medical decision. Each test must be medically necessary on its own, so standard batteries are not accepted by default. A report must go to the referring provider. [2] |
- CMS Medicare Coverage Database: Billing and Coding Article A57481 Psychological and Neuropsychological Testing, WPS (revision effective 10/31/2024), checked October 30, 2026
- CMS Medicare Coverage Database: LCD L34646 Psychological and Neuropsychological Testing, WPS (revision effective 10/31/2024), checked October 30, 2026
Medicare, First Coast (FL, PR, VI)
First Coast LCD L34520 Psychological and Neuropsychological Tests and billing article A57780 · Florida
| 96130 | Listed (covered when a listed ICD-10 code supports medical necessity) [1] |
|---|---|
| 96131 | Listed (covered when a listed ICD-10 code supports medical necessity) [1] |
| 96132 | Listed (covered when a listed ICD-10 code supports medical necessity) [1] |
| 96133 | Listed (covered when a listed ICD-10 code supports medical necessity) [1] |
| 96136 | Listed (covered when a listed ICD-10 code supports medical necessity) [1] |
| 96137 | Listed (covered when a listed ICD-10 code supports medical necessity) [1] |
| 96138 | Listed (covered when a listed ICD-10 code supports medical necessity) [1] |
| 96139 | Listed (covered when a listed ICD-10 code supports medical necessity) [1] |
| Diagnoses | Unlike WPS, the billing article carries a long ICD-10 list (1,789 codes in the current version) that supports medical necessity for 96130 to 96139 and G0451. Neuropsychological testing is also described as not supported or excluded by diagnosis alone. [1][2] |
| Visit limits | Testing typically takes 4 to 6 hours; over several days, combine the time and report it on the last date of service. If testing exceeds eight hours, medical necessity for the extra time should be documented in the report. [1][2] |
| Who can bill | The performing provider reports the codes: clinical psychologist, neuropsychologist or physician. A treating physician who only reads the report or explains results to the patient or family does not bill these codes. [2] |
| Also | Not covered when administered for educational or vocational purposes that do not establish medical management, when brain or emotional function abnormalities are not suspected, for self-administered inventories or cognitive screens, or when repeated without a decision to start or continue therapy. Routine testing on nursing home entry is not covered. [2] |
- CMS Medicare Coverage Database: Billing and Coding Article A57780 Psychological and Neuropsychological Tests, First Coast (revision effective 10/01/2026), checked October 30, 2026
- CMS Medicare Coverage Database: LCD L34520 Psychological and Neuropsychological Tests, First Coast (revision effective 07/01/2020), checked October 30, 2026
Medicare, Novitas (AR, CO, DE, DC, LA, MD, MS, NJ, NM, OK, PA, TX)
Novitas LCD L35101 Psychiatric Codes, Section II Psychological and Neuropsychological Testing · AR, CO, DE, DC, LA, MD, MS, NJ, NM, OK, PA, TX
| Where it applies | Testing is for suspected mental illness where clarification is needed for the diagnosis and treatment plan. When a psychiatric condition or dementia is already diagnosed, testing adds value only if results would significantly change understanding or treatment, for example a change in condition or a capacity question. [1] |
|---|---|
| Visit limits | Each test must be medically necessary; standardized batteries are acceptable only if each component test is. Depending on the issues, a typical battery may require 7 to 10 hours including administration, scoring and interpretation. [1] |
| Referral | A physician order is needed when an independent psychologist (not a clinical psychologist) performs the tests. [1] |
| Who can bill | Independently practicing psychologists may provide the tests when a physician orders them. PTs, OTs and SLPs may do aphasia assessment under general supervision of a physician or clinical psychologist. NPs, CNSs and PAs follow Benefit Policy Manual chapter 15, section 80.2. [1] |
| Also | Documentation must show the reason for referral, tests administered with scoring, interpretation and time, the present evaluation, the diagnosis or suspected diagnosis, recommendations, and who performed the service. Brief screens such as the Folstein Mini-Mental Status Exam are not separately classified as testing. [1] |
- CMS Medicare Coverage Database: LCD L35101 Psychiatric Codes, Novitas (revision effective 01/01/2024), checked October 30, 2026
Medicare, CGS (KY, OH)
CGS LCD L34353 Outpatient Psychiatry and Psychology Services, central nervous system assessments and tests · KY, OH
| Visit limits | Psychological testing typically takes 4 to 6 hours. Time over several days is combined and reported on the last date of service. Above eight hours a report may be requested to show medical necessity. Diagnostic testing is not subject to the outpatient mental health treatment limitation. [1] |
|---|---|
| Who can bill | Payment for psychological testing is limited to physicians, clinical psychologists, and on a limited basis to qualified non-physician practitioners such as speech language pathologists for aphasia evaluation. A treating physician who only reads another clinician's report does not bill the testing codes. [1] |
| Also | Documentation: the record must indicate the presence of mental illness or signs of it, plus the tests performed, scoring and interpretation, and time. Each test must be individually necessary, repeat testing needs a change in condition, and routine testing of nursing home patients is screening and not covered. The LCD text still cites the retired 96101 to 96120 code range. [1] |
Medicare, Wellpoint Federal (CT, IL, MA, ME, MN, NH, NY, RI, VT, WI)
Wellpoint Federal LCD L33632 Psychiatry and Psychology Services, Section VII Central Nervous System Assessments/Tests · CT, IL, MA, ME, MN, NH, NY, RI, VT, WI
| Where it applies | Testing used when mental illness is not suspected is a screening procedure that Medicare does not cover. Changes in mental illness can justify new testing, but repeat testing not needed for diagnosis or continued treatment is considered medically unnecessary. [1] |
|---|---|
| Visit limits | Psychological testing typically takes 4 to 6 hours. If done over several days, the time is combined and reported all on the last date of service. If it exceeds eight hours, medical necessity for the extended time should be documented. [1] |
| Who can bill | Psychological testing is limited to physicians, clinical psychologists, and on a limited basis qualified non-physician practitioners. A physician who only reads or explains another clinician's testing report does not bill it; that is included in E/M payment. [1] |
| Also | Each test must be individually medically necessary; a standard battery is only necessary if each test in it is. Adjustment reactions or dysphoria on moving to a nursing facility do not justify testing, but a suspected serious mood disorder on admission may. [1] |
Aetna
Aetna Clinical Policy Bulletin 0158 Neuropsychological and Psychological Testing · All states
| 96116 | Listed (covered if the selection criteria in the bulletin are met) [1] |
|---|---|
| 96121 | Listed (covered if the selection criteria in the bulletin are met) [1] |
| 96130 | Listed (covered if the selection criteria in the bulletin are met) [1] |
| 96131 | Listed (covered if the selection criteria in the bulletin are met) [1] |
| 96132 | Listed (covered if the selection criteria in the bulletin are met) [1] |
| 96133 | Listed (covered if the selection criteria in the bulletin are met) [1] |
| 96136 | Listed (covered if the selection criteria in the bulletin are met) [1] |
| 96137 | Listed (covered if the selection criteria in the bulletin are met) [1] |
| 96138 | Listed (covered if the selection criteria in the bulletin are met) [1] |
| 96139 | Listed (covered if the selection criteria in the bulletin are met) [1] |
| 96146 | Listed (covered if the selection criteria in the bulletin are met) [1] |
| Where it applies | Testing is medically necessary when the hours requested do not exceed the reasonable time needed for the clinical question, the techniques are validated for the diagnostic question, age and population, are not redundant, and are the most updated version of the instrument. Pre-surgical clearance testing is generally not medically necessary. Testing for a mental health diagnosis falls under the mental health benefit; testing for a medical diagnosis such as TBI, stroke, epilepsy or Alzheimer's falls under the medical benefit. [1] |
| Diagnoses | Neuropsychological testing can distinguish ADHD from learning disabilities or language disorders when that remains unclear after history and exam, and may be necessary for neurologically complicated ADHD. It is rarely necessary for uncomplicated ADHD. It is not medically necessary for chronic fatigue syndrome or migraine, or when the member is actively abusing substances. [1] |
| Also | Autism testing follows CPB 0648. Diagnostic assessment for neurodiversity is considered not medically necessary. Testing for educational reasons is not covered because school systems usually provide it, and testing for employment, disability qualification or legal purposes is not covered. Computerized devices such as Cognitrax are experimental for screening healthy people. [1] |
UnitedHealthcare and Optum Behavioral
Optum reimbursement policy 2019RP501A, commercial prior authorization code list, Colorado Exchange list · All states
| 96130 | Listed (on the Optum commercial prior authorization list) [1] |
|---|---|
| 96131 | Listed (on the Optum commercial prior authorization list) [1] |
| 96132 | Not named (billable per the reimbursement policy; not on the commercial prior authorization list) [2][1] |
| 96133 | Not named (billable per the reimbursement policy; not on the commercial prior authorization list) [2][1] |
| 96136 | Listed (on the Optum commercial prior authorization list) [1] |
| 96137 | Listed (on the Optum commercial prior authorization list) [1] |
| 96138 | Listed (on the Optum commercial prior authorization list) [1] |
| 96139 | Listed (on the Optum commercial prior authorization list) [1] |
| 96146 | Limited (standalone only, for one computerized measure and no other measures) [2] |
| Visit limits | Base codes (96130, 96132, 96136, 96138) are billed one unit only per testing episode, even when testing spans several days. Later time goes on the add-on codes (96131, 96133, 96137, 96139). The single bill is submitted when the episode concludes with the evaluation report. [2] |
| Prior authorization | Optum's commercial list requires prior authorization for 96130, 96131 and 96136 to 96139. On UnitedHealthcare Exchange plans in Colorado (2026), authorization is only required if the administration and scoring code is submitted with 96130 and 96131. Check the member's state and product list. [1][3] |
| Also | Evaluation codes cannot be billed without test administration and scoring codes: a complete episode includes both series. Do not bill psychological (96130, 96131) and neuropsychological (96132, 96133) evaluation codes in the same episode; choose the one that matches the predominant service. Optum follows the APA billing and coding guide. [2] |
- Optum: Commercial Prior Authorization Code List BH01532-1-25 (09/26/2025), checked October 30, 2026
- Optum: Psychological and Neuropsychological Testing Reimbursement Policy 2019RP501A (copyright 2026), checked October 30, 2026
- UnitedHealthcare: Prior Authorization Code List, Exchange Plans in Colorado, behavioral health (effective 1/1/2026), checked October 30, 2026
Cigna and Evernorth
Evernorth Coverage Policy EN0258 Neuropsychological Testing (effective 9/15/2026) · All states
| 96116 | Listed (medically necessary when the policy criteria are met) [1] |
|---|---|
| 96121 | Listed (medically necessary when the policy criteria are met) [1] |
| 96130 | Not named (the policy addresses neuropsychological testing only) [1] |
| 96131 | Not named (the policy addresses neuropsychological testing only) [1] |
| 96132 | Listed (medically necessary when the policy criteria are met) [1] |
| 96133 | Listed (medically necessary when the policy criteria are met) [1] |
| 96136 | Limited (covered when medically necessary and used to report neuropsychological test administration and scoring) [1] |
| 96137 | Limited (covered when medically necessary and used to report neuropsychological test administration and scoring) [1] |
| 96138 | Limited (covered when medically necessary and used to report neuropsychological test administration and scoring) [1] |
| 96139 | Limited (covered when medically necessary and used to report neuropsychological test administration and scoring) [1] |
| Where it applies | All of the following: the information will be used for clinical decision making, there are symptoms indicative of a significant decline in cognitive or behavioral functioning, and there is a reasonable suspicion of a listed condition. [1] |
| Diagnoses | Listed suspicions include autism spectrum disorder, brain tumor, anoxic or hypoxic episode, CNS infection with neurocognitive problems, dementia, demyelinating disease, epilepsy, toxic exposure, Parkinson's or Huntington's disease, postconcussion syndrome, stroke and traumatic brain injury. Concussion and mild cognitive impairment qualify only with a change in mental status, suspicion of an underlying CNS condition and failed standard treatment. [1] |
| Prior authorization | Evernorth's Massachusetts supplemental form for behavioral providers (01/2024) says authorization for psychological testing is not routinely required and to contact Evernorth Behavioral Health for account-specific information. We found no national prior authorization rule for Cigna. [2] |
| Also | Not covered for any indication not listed, including educational or vocational assessment, improving academic performance, baseline assessment of function, monitoring chronic conditions with no significant new change, and screening. Computerized neuropsychological testing that needs no clinician interpretation and report is experimental. A number of states mandate autism coverage, so check the plan. [1] |
- Evernorth (Cigna): Coverage Policy EN0258 Neuropsychological Testing (effective 9/15/2026), checked October 30, 2026
- Evernorth Behavioral Health: Massachusetts Psychological and Neuropsychological Assessment Supplemental Form (01/2024), checked October 30, 2026
BCBS Illinois, New Mexico and Oklahoma (HCSC)
HCSC Clinical Payment and Coding Policy CPCP008 Psychological and Neuropsychological Testing (effective March 2, 2026) · IL, NM, OK
| 96130 | Listed (reserved for full psychological or neuropsychological assessments) [1] |
|---|---|
| 96131 | Listed (reserved for full psychological or neuropsychological assessments) [1] |
| 96132 | Listed (reserved for full psychological or neuropsychological assessments) [1] |
| 96133 | Listed (reserved for full psychological or neuropsychological assessments) [1] |
| 96136 | Listed (reserved for full psychological or neuropsychological assessments) [1] |
| 96137 | Listed (reserved for full psychological or neuropsychological assessments) [1] |
| 96138 | Listed (reserved for full psychological or neuropsychological assessments) [1] |
| 96139 | Listed (reserved for full psychological or neuropsychological assessments) [1] |
| 96146 | Limited (for brief or automated testing, with 96127) [1] |
| Diagnoses | Neuropsychological testing for ADHD is indicated only when there is remarkable evidence of medical or neurological history; uncomplicated ADHD psychological testing has an expected 3 to 4 hours. [1] |
| Visit limits | Psychological or neuropsychological testing is limited to once per calendar year; a second claim may get a records and medical necessity review. A minimum of 31 minutes is needed for any per-hour code and 16 minutes for a 30-minute code. Expected time: 8 hours for neuropsychological evaluations, 3 to 4 hours for pre-procedure readiness or uncomplicated ADHD. [1][2][3] |
| Who can bill | CPT 96130 to 96133 may only be billed by a Qualified Healthcare Professional with education and training in the area who is independently licensed in the state. People working or training under the QHP are technicians and bill 96138 and 96139. [1] |
| Also | Base codes (96112, 96116, 96130, 96132, 96136, 96138) are used once per testing episode, and the claim goes in after all testing is done, even across multiple days. Do not bill both psychological and neuropsychological evaluation codes in one episode. Brief inventories belong under 96127 or 96146, not the full evaluation codes. [1] |
- Blue Cross and Blue Shield of Oklahoma (HCSC): Clinical Payment and Coding Policy CPCP008 Psychological and Neuropsychological Testing, v1.0, effective 3/2/2026, checked October 30, 2026
- Blue Cross and Blue Shield of Illinois (HCSC): CPCP008 Psychological and Neuropsychological Testing, effective 3/2/2026, checked October 30, 2026
- Blue Cross and Blue Shield of New Mexico (HCSC): CPCP008 Psychological and Neuropsychological Testing, effective 3/2/2026, checked October 30, 2026
BlueCross BlueShield of South Carolina
Medical policy CAM 397 Psychological and Neuropsychological Testing · South Carolina
| 96116 | Listed (in the policy scope; authorization process applies) [1] |
|---|---|
| 96121 | Listed (in the policy scope; authorization process applies) [1] |
| 96130 | Listed (in the policy scope; authorization process applies) [1] |
| 96131 | Listed (in the policy scope; authorization process applies) [1] |
| 96132 | Listed (in the policy scope; authorization process applies) [1] |
| 96133 | Listed (in the policy scope; authorization process applies) [1] |
| 96136 | Listed (in the policy scope; authorization process applies) [1] |
| 96137 | Listed (in the policy scope; authorization process applies) [1] |
| 96138 | Listed (in the policy scope; authorization process applies) [1] |
| 96139 | Listed (in the policy scope; authorization process applies) [1] |
| Visit limits | Testing is limited to once per calendar year; more than one claim per year may get a records and medical necessity review. Base codes may only be used once per testing episode. Submit the claim after all testing services are complete, even across several days. [1] |
| Prior authorization | Initial testing requests must show a valid DSM or ICD-10 diagnosis (or rule-out) and a fully licensed clinician whose state board allows testing in their scope; if the patient was referred, the referral should come from a licensed physician or licensed behavioral health practitioner. List the requested CPT codes and related DSM diagnoses. Some contracts exclude testing or specific diagnoses. [1] |
| Who can bill | In South Carolina, reimbursement for testing is limited to physicians and psychologists or supervising psychologists eligible under the state Board of Examiners in Psychology. Licensed Professional Counselors are not authorized to perform psychological testing; requests from LPCs in other states are reviewed case by case. [1] |
| Also | Tests must not be primarily for educational purposes, including poor academic performance, accommodations, evaluation of learning disabilities, grade placement and IEP planning. Testing for job placement, disability claims or court purposes is also excluded. Autism testing by licensed psychoeducational specialists may be approved under the autism benefit (CAM 387). [1] |
- BlueCross BlueShield of South Carolina: Psychological and Neuropsychological Testing, CAM 397, checked October 30, 2026
Carelon Behavioral Health
Provider bulletin: Psychological/Neuropsychological Testing Update (undated) · All states
| 96116 | Listed (billing pairs shown in the bulletin) [1] |
|---|---|
| 96121 | Listed (billing pairs shown in the bulletin) [1] |
| 96131 | Listed (billing pairs shown in the bulletin) [1] |
| 96132 | Listed (billing pairs shown in the bulletin) [1] |
| 96133 | Listed (billing pairs shown in the bulletin) [1] |
| 96136 | Listed (billing pairs shown in the bulletin) [1] |
| 96137 | Listed (billing pairs shown in the bulletin) [1] |
| 96138 | Listed (billing pairs shown in the bulletin) [1] |
| 96139 | Listed (billing pairs shown in the bulletin) [1] |
| Diagnoses | A medical diagnosis cannot be accepted on a testing claim because testing is most often done for psychological symptoms. If the testing was done for a medical diagnostic reason, the claim is likely not covered under the behavioral health benefit and should go to the member's medical insurer. [1] |
| Visit limits | Add-on codes must be billed on the same claim, same patient and same date of service as the base code. If services ran over several days, do not bill until the service concludes; use the conclusion date for both codes, with the total time. [1] |
| Prior authorization | Lack of prior authorization on file is the first of five common denial trends. Providers should submit testing requests through the Carelon provider portal rather than fax. If testing was done without authorization and denied, standard appeals apply. [1] |
- Carelon Behavioral Health: Psychological/Neuropsychological Testing Update (undated provider bulletin), checked October 30, 2026
Oklahoma Medicaid (SoonerSelect)
SoonerSelect plans: Oklahoma Complete Health, Aetna Better Health of Oklahoma, Humana Healthy Horizons · Oklahoma
| 96116 | Listed (no prior authorization required) [1] |
|---|---|
| 96121 | Listed (no prior authorization required) [1] |
| 96130 | Listed (prior authorization required) [1] |
| 96131 | Listed (prior authorization required) [1] |
| 96132 | Listed (prior authorization required) [1] |
| 96133 | Listed (prior authorization required) [1] |
| 96136 | Listed (prior authorization required) [1] |
| 96137 | Listed (prior authorization required) [1] |
| 96138 | Listed (prior authorization required) [1] |
| 96139 | Listed (prior authorization required) [1] |
| 96146 | Listed (no prior authorization required) [1] |
| Visit limits | Request units per code: 1 unit equals 1 hour for evaluation services (including report writing and feedback) and 1 unit equals 30 minutes for test administration and scoring. More units need a new authorization request. [1] |
| Prior authorization | Required for 96130, 96131, 96132, 96133 and 96136 to 96139 for all three plans, whatever the number of units or hours. Start dates: April 1, 2025 for Oklahoma Complete Health and Aetna Better Health; May 1, 2025 for Humana. The 90791 diagnostic interview, 96116, 96121, 96146 and 90887 do not need PA. Decisions come within 72 hours when documentation is complete; authorizations last 6 months. [1] |
| Referral | Members may self-refer if a physician, psychiatrist, psychologist or licensed mental health professional has recommended or requested the evaluation, and that recommendation must be documented with the PA request. A diagnostic interview (90791) before testing is expected, or equivalent clinical information. [1] |
| Managed care plans | The three plans use different criteria: InterQual at Oklahoma Complete Health, Milliman Care Guidelines at Aetna Better Health of Oklahoma, and MCG plus OHCA criteria at Humana Healthy Horizons. All use Availity Essentials for PA. [1] |
| Also | Not appropriate when results are used for academic placement or purposes or to diagnose a learning disorder only; other school referrals are reviewed case by case. Testing is not medically necessary when used primarily for legal or judicial purposes such as competency. Mood diagnoses that a full diagnostic interview can establish do not need testing. [1] |
Nevada Medicaid
Provider Type 26 Billing Guide, Psychologist (updated 01/12/2026) · Nevada
| 96130 | Listed (no prior authorization required for the evaluation codes themselves) [1] |
|---|---|
| 96131 | Listed (no prior authorization required for the evaluation codes themselves) [1] |
| 96132 | Listed (prior authorization required) [1] |
| 96133 | Listed (prior authorization required) [1] |
| 96136 | Listed (prior authorization required) [1] |
| 96137 | Listed (prior authorization required) [1] |
| 96138 | Listed (prior authorization required) [1] |
| 96139 | Listed (prior authorization required) [1] |
| 96146 | Listed (prior authorization required) [1] |
| Visit limits | A psychological testing PA request must include one unit of 96130 and one unit of 96136 or 96138. A neuropsychological request must include one unit of 96132 and one unit of 96136 or 96138. [1] |
| Prior authorization | PA is required for 96136 to 96139 (psychological and neuropsychological), 96132 and 96133, and 96146. The request must show medical necessity and units must not exceed the reasonable time to answer the referral question. Forms: FA-10A psychological, FA-10B neuropsychological, FA-10D automated testing. [1] |
| Who can bill | Provider type 26 enrolls psychologists, neuropsychology, child and adolescent psychology, clinical psychology, psychological assistants, interns and trainees under specialty codes. [1] |
- Nevada Medicaid: Provider Type 26 Billing Guide, Psychologist (updated 01/12/2026), checked October 30, 2026
South Carolina Medicaid (RBHS)
Rehabilitative Behavioral Health Services Provider Manual, Section 4 (updated 01/01/25) · South Carolina
| 96130 | Listed (licensed psychologist (modifier AH), or Licensed Psychoeducational Specialist (modifier HO) in the manual's DAODAS-only table; counts toward 24 units per year) [1] |
|---|---|
| 96131 | Listed (licensed psychologist (modifier AH), or Licensed Psychoeducational Specialist (modifier HO) in the manual's DAODAS-only table; counts toward 24 units per year) [1] |
| 96136 | Listed (licensed psychologist (modifier AH), or Licensed Psychoeducational Specialist (modifier HO) in the manual's DAODAS-only table; counts toward 24 units per year) [1] |
| 96137 | Listed (licensed psychologist (modifier AH), or Licensed Psychoeducational Specialist (modifier HO) in the manual's DAODAS-only table; counts toward 24 units per year) [1] |
| Visit limits | Per day: 96130 and 96136 once, 96131 up to five hours, 96137 up to six units. Per year: no more than 24 units in combination across 96130, 96131, 96136 and 96137. [1] |
| Who can bill | In the general table of SC Medicaid's Rehabilitative Behavioral Health Services manual, 96130, 96131, 96136 and 96137 are listed only for the Licensed Psychologist (modifier AH). The manual's DAODAS-only table also lists the Licensed Psychoeducational Specialist (modifier HO) for these codes and adds 96138, 96139 and 96146, limited to 40 units per year in combination. 96132 and 96133 do not appear. [1] |
Washington Apple Health
Mental Health Services Billing Guide (October 1, 2026) · Washington
| 96130 | Listed (lifetime limit of 12 units in combination with 96136 to 96139 and 96146) [1] |
|---|---|
| 96131 | Listed (lifetime limit of 12 units in combination with 96136 to 96139 and 96146) [1] |
| 96132 | Listed (15 units in combination with 96136 to 96139 and 96146) [1] |
| 96133 | Listed (15 units in combination with 96136 to 96139 and 96146) [1] |
| 96136 | Listed (counts toward the limit under 96130 or 96132) [1] |
| 96137 | Listed (counts toward the limit under 96130 or 96132) [1] |
| 96138 | Listed (counts toward the limit under 96130 or 96132) [1] |
| 96139 | Listed (counts toward the limit under 96130 or 96132) [1] |
| 96146 | Listed (counts toward the limit under 96130 or 96132) [1] |
| Visit limits | Psychological testing is limited to twelve units of any combination of 96130, 96131, 96136, 96137, 96138 or 96139 without PA per client, per lifetime; HCA reviews requests to exceed it. Neuropsychological testing allows 15 units in the coverage table, and billing more requires PA. [1] |
| Who can bill | HCA reimburses neuropsychological testing (96132, 96133, 96136, 96137) when the provider is currently licensed in Washington to practice psychology or clinical neuropsychology and is either board certified in clinical neuropsychology or has the doctoral degree, internship and two years of specialized neuropsychology training the guide lists. Credentials must be furnished on request. [1] |
| Also | A psychiatric diagnostic interview (90791 or 90792) and psychological testing (96130, 96131, 96136 to 96139) cannot be billed on the same day without PA. HCA does not cover testing if the client is actively abusing a substance, in acute withdrawal or newly in recovery. The evaluation must be done by the qualified professional before test administration and may be billed on a separate day. [1] |
North Carolina Medicaid
Clinical Coverage Policy 8C, Outpatient Behavioral Health Services by Direct-Enrolled Providers (amended 09/01/2021) · North Carolina
| Where it applies | All criteria are required: a DSM-5 diagnosis or suspicion of one, functional impairment consistent with it, the ability to engage in testing, and no evidence that other tests would be more effective. Testing results must inform treatment selection and planning. [1] |
|---|---|
| Telehealth POS | Policy 8C (amended September 1, 2021) says testing is not covered if the service is not provided in person. Billing must occur only on dates when the beneficiary is seen in person, although testing activities on other dates may be billed. Check NC Medicaid's current telehealth policy. [1] |
| Visit limits | Per Policy 8C (amended September 1, 2021), unmanaged coverage is limited to eight hours of psychological testing per state fiscal year; prior approval is required to exceed it. A limit of eight units (hours) of testing per date of service also applies. A diagnostic interview is not allowed on the same day as testing by the same provider. [1] |
| Also | Not covered for educational testing, when requested by the school or legal system unless medically necessary, when measures lack standardized norms or documented validity, or when the focus is not the symptoms of the DSM-5 diagnosis. A written report to the referral source is required. [1] |
Ohio Medicaid
Prior Authorization Requirements for Behavioral Health Services (revised May 2019) · Ohio
| 96116 | Listed (up to 12 hours or encounters per patient per calendar year before PA) [1] |
|---|---|
| 96121 | Listed (up to 12 hours or encounters per patient per calendar year before PA) [1] |
| 96130 | Listed (up to 12 hours or encounters per patient per calendar year before PA) [1] |
| 96131 | Listed (up to 12 hours or encounters per patient per calendar year before PA) [1] |
| 96132 | Listed (up to 8 hours per patient per calendar year before PA) [1] |
| 96133 | Listed (up to 8 hours per patient per calendar year before PA) [1] |
| Visit limits | Ohio Medicaid's behavioral health PA sheet (revised May 2019, services under OAC 5160-27): up to 12 hours or encounters per patient per calendar year for 96130, 96131, 96112, 96113, 96116 and 96121, and 8 hours for 96132 and 96133. The sheet does not name 96136 to 96139. [1] |
| Prior authorization | Per Ohio Medicaid's May 2019 behavioral health PA sheet, prior authorization is required only when the annual limit is reached. Check the current rule and the member's managed care plan. [1] |
MassHealth (Massachusetts)
State rate regulation 101 CMR 329.00 (Cornell LII copy) · Massachusetts
Unofficial source · confirm with the payer: some facts in this row come from a secondary source, not the payer.
| 96130 | Listed (psychological testing evaluation services, first hour (has an allowable fee in 101 CMR 329.04)) [1] Unofficial source · confirm with the payer |
|---|---|
| 96131 | Listed (each additional hour (has an allowable fee in 101 CMR 329.04)) [1] Unofficial source · confirm with the payer |
| 96132 | Listed (neuropsychological testing evaluation services, first hour (has an allowable fee in 101 CMR 329.04)) [1] Unofficial source · confirm with the payer |
| 96133 | Listed (each additional hour (has an allowable fee in 101 CMR 329.04)) [1] Unofficial source · confirm with the payer |
| 96136 | Listed (test administration and scoring by a clinician, first 30 minutes (has an allowable fee in 101 CMR 329.04)) [1] Unofficial source · confirm with the payer |
| 96137 | Listed (each additional 30 minutes (has an allowable fee in 101 CMR 329.04)) [1] Unofficial source · confirm with the payer |
| 96138 | Listed (test administration and scoring by a technician, first 30 minutes (has an allowable fee in 101 CMR 329.04)) [1] Unofficial source · confirm with the payer |
| 96139 | Listed (each additional 30 minutes (has an allowable fee in 101 CMR 329.04)) [1] Unofficial source · confirm with the payer |
| Where it applies | The regulation sets allowable fees for psychological assessments. It is a rate regulation, so it does not say which diagnoses qualify or whether prior authorization is needed. [1] Unofficial source · confirm with the payer |
| Who can bill | Fees are set for assessments provided by a psychologist, and for test administration and scoring by a technician. [1] Unofficial source · confirm with the payer |
| Also | The page notes the section was last amended effective 4/25/2025. The page shows two versions with different amounts for some codes, so confirm the current fee with MassHealth. [1] Unofficial source · confirm with the payer |
- Cornell LII copy of 101 CMR 329.04, Allowable Fees for Psychological Assessments (amended eff. 4/25/2025) (secondary source), checked October 30, 2026
Texas Medicaid (managed care plan guideline)
Texas Children's Health Plan policy 6673, which points to the Texas Medicaid provider manual · Texas
| 96130 | Limited (psychological testing evaluation, first hour, within 8 hours per client per calendar year, more with prior authorization) [1] |
|---|---|
| 96131 | Limited (add-on, each additional hour, within 8 hours per client per calendar year, more with prior authorization) [1] |
| 96132 | Limited (neuropsychological evaluation, first hour, within 8 hours per client per calendar year, more with prior authorization) [1] |
| 96133 | Limited (add-on, each additional hour, within 8 hours per client per calendar year, more with prior authorization) [1] |
| 96136 | Limited (test administration and scoring, first 30 minutes, within 8 hours per client per calendar year, more with prior authorization) [1] |
| 96137 | Limited (add-on, each additional 30 minutes, within 8 hours per client per calendar year, more with prior authorization) [1] |
| Where it applies | The plan reviews psychological, neurobehavioral and neuropsychological testing billed outside the limits in the Texas Medicaid Provider Procedures Manual behavioral health handbook. [1] |
| Diagnoses | Medical necessity can be shown when testing is needed for a differential diagnosis that interview and brief rating scales cannot settle. [1] |
| Visit limits | Testing is limited to four hours per client per day and eight hours per client per calendar year. More testing needs prior authorization with clinical documentation. [1] |
| Prior authorization | A request over the limit must list current DSM diagnoses, the type of testing and procedure codes, the rationale and symptoms, and previous testing history and results. [1] |
| Also | Routine testing at facility admission is not considered medically necessary. Testing for legal, custody or placement purposes is not covered unless court ordered, and school-requested testing is not generally covered. [1] |
Kaiser Permanente (Georgia region)
Kaiser Permanente Georgia region review criteria 01-14, last revised 4/16/2026 · Georgia
| 96132 | Limited (neuropsychological evaluation, first hour (listed in the Georgia region neuropsychological evaluation criteria)) [1] |
|---|---|
| 96133 | Limited (add-on, each additional hour (listed in the Georgia region neuropsychological evaluation criteria)) [1] |
| 96136 | Limited (test administration and scoring, first 30 minutes (listed in the Georgia region neuropsychological evaluation criteria)) [1] |
| 96137 | Limited (add-on, each additional 30 minutes (listed in the Georgia region neuropsychological evaluation criteria)) [1] |
| 96138 | Limited (technician administration and scoring, first 30 minutes (listed in the Georgia region neuropsychological evaluation criteria)) [1] |
| 96139 | Limited (add-on, technician, each additional 30 minutes (listed in the Georgia region neuropsychological evaluation criteria)) [1] |
| Where it applies | The criteria cover neuropsychological evaluations in the Georgia region. [1] |
| State law | Not covered services include learning disability assessments, disability determination, educational services qualification, court-directed evaluations and IQ determination. [1] |
| Diagnoses | Indications include a diagnosed or suspected neurological disorder with behavioral, emotional or cognitive changes, and differential diagnosis of neurological versus psychological conditions. [1] |
| Visit limits | Requests for outside adult and child and adolescent evaluations are first reviewed to see whether Kaiser Permanente can provide the service internally. If it can, the outside evaluation is not approved. [1] |
| Also | Contraindications include suspected developmental delay alone, and conditions better served by behavioral or psychoeducational assessment, such as suspected ASD at any age. ADHD, mood disorders and autism are listed as conditions for behavioral health or pediatric evaluation. [1] |
Kaiser Permanente (Washington)
Kaiser Foundation Health Plan of Washington, authorization code ranges for mental health · Washington
| 96130 | Listed (appears in the Washington "Psychological Testing" authorization code range) [1] |
|---|---|
| 96131 | Listed (appears in the Washington "Psychological Testing" authorization code range) [1] |
| 96132 | Listed (appears in the Washington "Neuropsychological Testing" authorization code range) [1] |
| 96133 | Listed (appears in the Washington "Neuropsychological Testing" authorization code range) [1] |
| 96136 | Listed (appears in the Washington "Neuropsychological Testing" authorization code range) [1] |
| 96137 | Listed (appears in the Washington "Neuropsychological Testing" authorization code range) [1] |
| 96138 | Listed (appears in the Washington "Neuropsychological Testing" authorization code range) [1] |
| 96139 | Listed (appears in the Washington "Neuropsychological Testing" authorization code range) [1] |
| Where it applies | The neuropsychological request range lists 96132, 96133 and 96136 to 96139, and also 96130 and 96131. The psychological testing range lists 96130 and 96131 with 90791. [1] |
| Prior authorization | Kaiser Permanente Washington groups testing into two authorization request types, "Neuropsychological Testing" (96132) and "Psychological Testing" (96130), each with a code range. Use the Pre-authorization Code Check tool for the exact requirements. [1] |
| Also | The page says the information does not guarantee coverage or payment. Services must be medically necessary and are subject to the patient's coverage agreement and limits. [1] |
- Kaiser Permanente Washington: Mental Health authorization code ranges (change log through 03/16/2026), checked October 30, 2026
New York Medicaid (fee schedule and Anthem plan form)
eMedNY clinical psychology fee schedule, plus Anthem NY Medicaid plan authorization form · New York
| 96130 | Listed (psychological testing evaluation, first hour (on the eMedNY clinical psychology fee schedule)) [1] |
|---|---|
| 96131 | Listed (add-on, each additional hour (on the eMedNY schedule)) [1] |
| 96136 | Listed (test administration and scoring, first 30 minutes (on the eMedNY schedule)) [1] |
| 96137 | Listed (add-on, each additional 30 minutes (on the eMedNY schedule)) [1] |
| 96138 | Limited (on Anthem Medicaid's authorization form: only one unit allowed) [2] |
| 96139 | Limited (on Anthem Medicaid's authorization form as an add-on to 96138) [2] |
| Visit limits | Anthem Medicaid says requests for placement, disability evaluations and forensic purposes are not covered. Educational testing or learning disability assessment should go to the public school system. [2] |
| Prior authorization | Anthem Blue Cross and Blue Shield HP (a NY Medicaid plan) uses a request form sent through Availity, and allows only one unit each of 96130, 96136 and 96138. [2] |
| Payment | The eMedNY clinical psychology fee schedule lists 96130, 96131, 96136 and 96137 with a non-facility and a facility fee. Listed fees are the maximum Medicaid fees. The schedule posted on eMedNY is effective October 1, 2023. [1] |
| Also | Anthem Medicaid says a diagnostic interview and screening measures should be completed before a testing request. Neuropsychological and autism testing use their own forms. [2] |
- eMedNY: Clinical Psychology Procedure Codes & Fee Schedule (effective October 1, 2023), checked October 30, 2026
- Anthem Blue Cross and Blue Shield HP (NY Medicaid): Request for Authorization: Psychological Testing (February 2026), checked October 30, 2026
Medi-Cal (Anthem Blue Cross plan forms)
Anthem Blue Cross Medi-Cal Managed Care authorization forms, February 2026 · California
| 96130 | Limited (on Anthem Medi-Cal's autism spectrum disorder testing authorization form (one unit maximum)) [1] |
|---|---|
| 96131 | Limited (on Anthem Medi-Cal's autism spectrum disorder testing authorization form) [1] |
| 96132 | Limited (on Anthem Medi-Cal's neuropsychological testing authorization form) [2] |
| 96133 | Limited (on Anthem Medi-Cal's neuropsychological testing authorization form) [2] |
| 96136 | Limited (on Anthem Medi-Cal's autism spectrum disorder testing authorization form (one unit maximum)) [1] |
| 96137 | Limited (on Anthem Medi-Cal's autism spectrum disorder testing authorization form) [1] |
| 96138 | Limited (on Anthem Medi-Cal's autism spectrum disorder testing authorization form (one unit maximum)) [1] |
| 96139 | Limited (on Anthem Medi-Cal's autism spectrum disorder testing authorization form) [1] |
| Diagnoses | For neuropsychological testing, Anthem says it may be medically necessary with a cognitive or behavioral impairment related to a known or suspected medical or neurological condition, and testing must impact medical treatment planning. [2] |
| Visit limits | Anthem says neuropsychological assessment is not considered medically necessary for behavioral disorders, including ADHD. [2] |
| Prior authorization | Anthem Blue Cross (Medi-Cal Managed Care) asks that its autism testing form be submitted through Availity Essentials before services are rendered. Neuropsychological testing has its own form. [1] |
| Also | The autism testing form says psychologists should complete a diagnostic interview and screening measures first, and that placement, disability and forensic requests are not covered. Forms are dated February 2026 and apply to one plan, not all of Medi-Cal. [1] |
Pennsylvania Medicaid (PerformCare and Philadelphia CBH)
PerformCare testing request form (Capital, Franklin and Fulton counties) and Philadelphia CBH bulletin 24-15 · Pennsylvania
| 96130 | Limited (needs prior authorization at PerformCare (Capital, Franklin and Fulton counties)) [1] |
|---|---|
| 96131 | Limited (needs prior authorization at PerformCare (Capital, Franklin and Fulton counties)) [1] |
| 96132 | Limited (needs prior authorization at PerformCare (Capital, Franklin and Fulton counties)) [1] |
| 96133 | Limited (needs prior authorization at PerformCare (Capital, Franklin and Fulton counties)) [1] |
| 96136 | Limited (needs prior authorization at PerformCare (Capital, Franklin and Fulton counties)) [1] |
| 96137 | Limited (needs prior authorization at PerformCare (Capital, Franklin and Fulton counties)) [1] |
| 96138 | Limited (needs prior authorization at PerformCare (Capital, Franklin and Fulton counties)) [1] |
| 96139 | Limited (needs prior authorization at PerformCare (Capital, Franklin and Fulton counties)) [1] |
| Visit limits | PerformCare will not authorize 96130 and 96132 at the same time. It authorizes whichever matches the testing request. Test review with the member is limited to 1 hour maximum. [1] |
| Prior authorization | PerformCare says prior authorization is required. It issues the approved units under 96130 for psychological testing or 96132 for neuropsychological testing, and providers bill the combination of codes. [1] |
| Managed care plans | Philadelphia's Community Behavioral Health changed its rule effective June 10, 2024: it requires preauthorization for 96130 and 96131, and for 96136 and 96137, using its own request form. [2][2] |
| Also | PerformCare only issues the authorization after the provider mails or faxes the testing results. Testing for educational, vocational or legal purposes, or routine for treatment entry, is not authorized. [1] |
How to use the table
Pick a payer, a state or a code, and the table keeps only the rows that match. Open a row for every field and its numbered sources. A fact marked "Unofficial source · confirm with the payer" comes from a secondary source, such as a professional association or a billing guide, because we couldn't open the payer's own document; check it with the payer before you rely on it.
Every payer and state on the table
- National payers: Medicare (national), Aetna, UnitedHealthcare and Optum Behavioral, Cigna and Evernorth, Carelon Behavioral Health.
- Regional plans and contractors: Medicare, WPS states (IA, IN, KS, MI, MO, NE), Medicare, First Coast (FL, PR, VI), Medicare, Novitas (AR, CO, DE, DC, LA, MD, MS, NJ, NM, OK, PA, TX), Medicare, CGS (KY, OH), Medicare, Wellpoint Federal (CT, IL, MA, ME, MN, NH, NY, RI, VT, WI), BCBS Illinois, New Mexico and Oklahoma (HCSC), BlueCross BlueShield of South Carolina, Kaiser Permanente (Georgia region), Kaiser Permanente (Washington).
- Medicaid: all states side by side, and Oklahoma Medicaid (SoonerSelect), Nevada Medicaid, South Carolina Medicaid (RBHS), Washington Apple Health, North Carolina Medicaid, Ohio Medicaid, MassHealth (Massachusetts) (unofficial), Texas Medicaid (managed care plan guideline), New York Medicaid (fee schedule and Anthem plan form), Medi-Cal (Anthem Blue Cross plan forms), Pennsylvania Medicaid (PerformCare and Philadelphia CBH).
Codes by payer
What a payer's own text says about one code: units, time rules, authorization and who can bill it.
- 96130: Medicare (national), UnitedHealthcare and Optum Behavioral, Washington Apple Health, South Carolina Medicaid (RBHS), Nevada Medicaid.
- 96132: Medicare (national), Nevada Medicaid.
- 96136: Medicare (national), UnitedHealthcare and Optum Behavioral.
- 96138: Medicare (national), BCBS Illinois, New Mexico and Oklahoma (HCSC).
- 96146: Medicare (national), UnitedHealthcare and Optum Behavioral.
- 96137: South Carolina Medicaid (RBHS).
Where the facts come from
From the payer's own policy, provider manual or fee schedule, from CMS for Medicare, a state Medicaid agency or the statute itself: 37 official documents. Where no official document could be opened, from a secondary source that we cite and label: 1 of them. Each fact links to its source and shows the day we opened it (October 30, 2026 for the latest). No source, no fact.
The same table exists for dietitians and MNT, and for psychotherapy, pediatric speech and OT and physical therapy.