96138 with BCBS Illinois, New Mexico and Oklahoma (HCSC): what the policy says
The short answerYes, for technician-administered testing under a QHP. Bill 96138 once per episode for the first 30 minutes and 96139 for more; at least 16 minutes are needed to report a 30-minute code.
By Javier Alvarez · Updated · 1 min read
1 row: Blue Cross and Blue Shield (HCSC). Public policy, not the member's benefits.
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
What BCBS Illinois, New Mexico and Oklahoma (HCSC)'s policy says about 96138
96138 is the CPT code for psychological or neuropsychological test administration and scoring by technician, first 30 minutes. At BCBS Illinois, New Mexico and Oklahoma (HCSC) it is listed: named in the payer's public policy. Each line below is from the cited text:
- When it pays. A minimum of 16 minutes must be provided to report a 30-minute code. (Blue Cross and Blue Shield of Oklahoma (HCSC), checked October 30, 2026)
- Units. 96138 is a base code used once per testing episode. (Blue Cross and Blue Shield of Oklahoma (HCSC), checked October 30, 2026)
- Who can bill it. People working or training under the supervision of the QHP are technicians and bill 96138 and 96139. (Blue Cross and Blue Shield of Oklahoma (HCSC), checked October 30, 2026)
96138 at other payers
- 96138 with Medicare (national): listed.
The rest of BCBS Illinois, New Mexico and Oklahoma (HCSC)'s psychological testing rules
The BCBS Illinois, New Mexico and Oklahoma (HCSC) row has its codes, telehealth rule, limits and authorization, each with its source. Before the claim goes out, compare it with the row in the table above.