Medicare, First Coast (FL, PR, VI) psychological testing coverage: codes, limits and who can bill
The short answerFirst Coast covers 96130 to 96139 when an ICD-10 code from the article's diagnosis list supports the testing and the LCD criteria are met. Each test must be necessary on its own, and over 8 hours the report must document why. Only the performing provider reports the testing codes.
By Javier Alvarez · Updated · 1 min read
1 row: Medicare (First Coast). Public policy, not the member's benefits.
Medicare, First Coast (FL, PR, VI)
First Coast LCD L34520 Psychological and Neuropsychological Tests and billing article A57780 · Florida
| 96130 | Listed (covered when a listed ICD-10 code supports medical necessity) [1] |
|---|---|
| 96131 | Listed (covered when a listed ICD-10 code supports medical necessity) [1] |
| 96132 | Listed (covered when a listed ICD-10 code supports medical necessity) [1] |
| 96133 | Listed (covered when a listed ICD-10 code supports medical necessity) [1] |
| 96136 | Listed (covered when a listed ICD-10 code supports medical necessity) [1] |
| 96137 | Listed (covered when a listed ICD-10 code supports medical necessity) [1] |
| 96138 | Listed (covered when a listed ICD-10 code supports medical necessity) [1] |
| 96139 | Listed (covered when a listed ICD-10 code supports medical necessity) [1] |
| Diagnoses | Unlike WPS, the billing article carries a long ICD-10 list (1,789 codes in the current version) that supports medical necessity for 96130 to 96139 and G0451. Neuropsychological testing is also described as not supported or excluded by diagnosis alone. [1][2] |
| Visit limits | Testing typically takes 4 to 6 hours; over several days, combine the time and report it on the last date of service. If testing exceeds eight hours, medical necessity for the extra time should be documented in the report. [1][2] |
| Who can bill | The performing provider reports the codes: clinical psychologist, neuropsychologist or physician. A treating physician who only reads the report or explains results to the patient or family does not bill these codes. [2] |
| Also | Not covered when administered for educational or vocational purposes that do not establish medical management, when brain or emotional function abnormalities are not suspected, for self-administered inventories or cognitive screens, or when repeated without a decision to start or continue therapy. Routine testing on nursing home entry is not covered. [2] |
- CMS Medicare Coverage Database: Billing and Coding Article A57780 Psychological and Neuropsychological Tests, First Coast (revision effective 10/01/2026), checked October 30, 2026
- CMS Medicare Coverage Database: LCD L34520 Psychological and Neuropsychological Tests, First Coast (revision effective 07/01/2020), checked October 30, 2026
What Medicare, First Coast (FL, PR, VI)'s documents say
The table above has every field we found for Medicare, First Coast (FL, PR, VI), with numbered sources. In short:
- Visit limits. Testing typically takes 4 to 6 hours; over several days, combine the time and report it on the last date of service. If testing exceeds eight hours, medical necessity for the extra time should be documented in the report.
- Who can bill. The performing provider reports the codes: clinical psychologist, neuropsychologist or physician. A treating physician who only reads the report or explains results to the patient or family does not bill these codes.
- Codes. 96130, 96131, 96132, 96133, 96136, 96137, 96138 and 96139 are listed.
Psychological testing coverage at other national payers
Medicare (national), Aetna, UnitedHealthcare and Optum Behavioral, Cigna and Evernorth and Carelon Behavioral Health.
Check Medicare, First Coast (FL, PR, VI)'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 Medicare (First Coast) with every other payer we checked.