Medicaid psychological testing coverage by state: codes, authorization and limits
The short answerIt depends on the state. We found public psychological testing rules for 11 Medicaid programs: California, Massachusetts, Nevada, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Texas and Washington. Each sets its own codes, prior authorization and limits, and managed care plans can add their own. Each state's page has its sources.
Unofficial source · confirm with the payer Rows marked unofficial come from a secondary source, not the state itself.
By Javier Alvarez · Updated · 4 min read
11 rows: Medicaid (by state). Public policy, not the member's benefits.
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] |
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] |
11 state Medicaid programs side by side
Each state runs Medicaid under its own manual and fee schedule, and managed care plans add their own rules on top. Each program below has its own page with every fact and its source.
| State | Codes | Prior authorization | Limits |
|---|---|---|---|
| Medi-Cal (Anthem Blue Cross plan forms) | 0 of 11 listed | 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. | Anthem says neuropsychological assessment is not considered medically necessary for behavioral disorders, including ADHD. |
| MassHealth (Massachusetts) (unofficial) | 8 of 11 listed | Not published: call the payer. | Not published: call the payer. |
| Nevada Medicaid | 9 of 11 listed | 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. | 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. |
| New York Medicaid (fee schedule and Anthem plan form) | 4 of 11 listed | 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. | 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. |
| North Carolina Medicaid | Not published: call the payer. | Not published: call the payer. | 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. |
| Ohio Medicaid | 6 of 11 listed | 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. | 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. |
| Oklahoma Medicaid (SoonerSelect) | 11 of 11 listed | 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. | 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. |
| Pennsylvania Medicaid (PerformCare and Philadelphia CBH) | 0 of 11 listed | 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. | 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. |
| South Carolina Medicaid (RBHS) | 4 of 11 listed | Not published: call the payer. | 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. |
| Texas Medicaid (managed care plan guideline) | 0 of 11 listed | 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. | 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. |
| Washington Apple Health | 9 of 11 listed | Not published: call the payer. | 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. |
Your state isn't here?
We only add a state when we could open a document that states the rule. Call the state's provider line or the member's managed care plan, and ask which codes psychologists can bill, whether prior authorization is needed and how many visits a year. The psychological testing table has every payer we checked.