New York Medicaid (fee schedule and Anthem plan form) psychological testing coverage: codes, limits and prior authorization
By Javier Alvarez · Updated · 1 min read
1 row: Medicaid (by state) · New York. Public policy, not the member's benefits.
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
What New York Medicaid (fee schedule and Anthem plan form)'s documents say
The table above has every field we found for New York Medicaid (fee schedule and Anthem plan form), with numbered sources. In short:
- 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.
- 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.
- Codes. 96130, 96131, 96136 and 96137 are listed. 96138 and 96139 are limited.
Other psychological testing rows for New York
Medicare, Wellpoint Federal (CT, IL, MA, ME, MN, NH, NY, RI, VT, WI).
Check New York Medicaid (fee schedule and Anthem plan form)'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 New York Medicaid with every other payer we checked.