96130 with Washington Apple Health: what the policy says
The short answerCovered, within a lifetime cap. Apple Health pays 12 units per client per lifetime for any combination of 96130, 96131, 96136 to 96139 and 96146 without prior authorization. 96130 cannot be billed the same day as 90791 or 90792 without PA.
By Javier Alvarez · Updated · 1 min read
1 row: Medicaid (by state) · Washington. Public policy, not the member's benefits.
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] |
What Washington Apple Health's policy says about 96130
96130 is the CPT code for psychological testing evaluation services, first hour. At Washington Apple Health it is limited: paid only in a narrow case, see the note. Each line below is from the cited text:
- Billed with. A psychiatric diagnostic interview (90791 or 90792) and psychological testing (96130, 96131, 96136 to 96139) cannot be billed on the same day without prior authorization. (Washington State Health Care Authority, checked October 30, 2026)
- When it pays. Evaluation services must always be performed by the qualified professional before test administration and may be billed on separate days. The record must hold a report with all components of a psychological assessment. (Washington State Health Care Authority, checked October 30, 2026)
- Units. Lifetime limit of 12 units for any combination of 96130, 96131, 96136, 96137, 96138, 96139 and 96146 without PA; HCA reviews requests to exceed it. (Washington State Health Care Authority, checked October 30, 2026)
96130 at other payers
- 96130 with Medicare (national): listed.
- 96130 with UnitedHealthcare and Optum Behavioral: limited.
- 96130 with South Carolina Medicaid (RBHS): limited.
- 96130 with Nevada Medicaid: listed.
The rest of Washington Apple Health's psychological testing rules
The Washington Apple Health 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.