Medicare, WPS states (IA, IN, KS, MI, MO, NE) psychological testing coverage: codes, limits and who can bill
The short answerWPS covers psychological and neuropsychological test administration and scoring (96136 to 96139, 96146) when the record shows why the tests were needed. Per-hour codes need at least 31 minutes. Screening, educational or vocational testing, and repeat testing without a medical decision are not covered.
By Javier Alvarez · Updated · 1 min read
1 row: Medicare (WPS). Public policy, not the member's benefits.
Medicare, WPS states (IA, IN, KS, MI, MO, NE)
WPS LCD L34646 Psychological and Neuropsychological Testing and billing article A57481 · IA, IN, KS, MI, MO, NE
| 96130 | Not named (evaluation services were removed from the LCD and article in 2020; the LCD addresses testing and scoring only) [1][2] |
|---|---|
| 96132 | Not named (same: evaluation codes 96130 to 96133 were removed from the article's code group) [1] |
| 96136 | Listed (test administration and scoring, clinician) [1] |
| 96137 | Listed (add-on) [1] |
| 96138 | Listed (test administration and scoring, technician under direct supervision) [1] |
| 96139 | Listed (add-on, technician) [1] |
| 96146 | Listed (automated testing and result) [1] |
| Where it applies | The LCD only addresses coverage for psychological and neuropsychological testing and scoring services, not the evaluation services (96130 to 96133). It lists many neuropsychological indications, such as mild or questionable deficits on mental status testing, pre-surgical cognitive evaluation, and cognitive deficits in children and adolescents. [2] |
| Diagnoses | Coverage is not based on diagnosis. The billing article lists no ICD-10 codes and says to report the appropriate diagnosis. Testing is not covered for Alzheimer's disease once a diagnosis has been made. [1] |
| Visit limits | A minimum of 31 minutes must be provided to report any per-hour code. Testing typically takes 4 to 8 hours. If testing runs over several days, combine the time and report it on the last day of service. Above eight hours, the contractor may ask for a report justifying the extra time. [1][2] |
| Who can bill | A provider with an appropriate state license, or a trained technician directly supervised by that provider. Billing needs a Medicare provider number and a license in the state where the service is performed. [2][1] |
| Also | Not reasonable and necessary when used as screening, for educational or vocational purposes that do not establish medical management, for self-administered or self-scored inventories, or when repeated without a medical decision. Each test must be medically necessary on its own, so standard batteries are not accepted by default. A report must go to the referring provider. [2] |
- CMS Medicare Coverage Database: Billing and Coding Article A57481 Psychological and Neuropsychological Testing, WPS (revision effective 10/31/2024), checked October 30, 2026
- CMS Medicare Coverage Database: LCD L34646 Psychological and Neuropsychological Testing, WPS (revision effective 10/31/2024), checked October 30, 2026
What Medicare, WPS states (IA, IN, KS, MI, MO, NE)'s documents say
The table above has every field we found for Medicare, WPS states (IA, IN, KS, MI, MO, NE), with numbered sources. In short:
- Visit limits. A minimum of 31 minutes must be provided to report any per-hour code. Testing typically takes 4 to 8 hours. If testing runs over several days, combine the time and report it on the last day of service. Above eight hours, the contractor may ask for a report justifying the extra time.
- Who can bill. A provider with an appropriate state license, or a trained technician directly supervised by that provider. Billing needs a Medicare provider number and a license in the state where the service is performed.
- Where it applies. The LCD only addresses coverage for psychological and neuropsychological testing and scoring services, not the evaluation services (96130 to 96133). It lists many neuropsychological indications, such as mild or questionable deficits on mental status testing, pre-surgical cognitive evaluation, and cognitive deficits in children and adolescents.
- Codes. 96130 and 96132 are not named in this policy. 96136, 96137, 96138, 96139 and 96146 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, WPS states (IA, IN, KS, MI, MO, NE)'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 (WPS) with every other payer we checked.