Carelon Behavioral Health psychological testing coverage: codes, limits and prior authorization
The short answerMissing prior authorization is the first of five common reasons Carelon lists for testing claim denials. Request it through the provider portal before testing. Add-on codes must be on the same claim as their base code, using the date the service concluded, and a medical diagnosis is not accepted on a behavioral health testing claim.
By Javier Alvarez · Updated · 1 min read
1 row: Carelon Behavioral Health. Public policy, not the member's benefits.
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
What Carelon Behavioral Health's documents say
The table above has every field we found for Carelon Behavioral Health, with numbered sources. In short:
- 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.
- 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.
- Codes. 96116, 96121, 96131, 96132, 96133, 96136, 96137, 96138 and 96139 are listed.
Psychological testing coverage at other national payers
Medicare (national), Aetna, UnitedHealthcare and Optum Behavioral and Cigna and Evernorth.
Check Carelon Behavioral Health's claim against the row
Before the claim goes out, compare it with the row above: the evaluation and administration codes pair the way the policy says, the hours fit any cap, the referral question is documented, and prior authorization covers the units. The psychological testing table compares Carelon Behavioral Health with every other payer we checked.