Medicare (national) psychological testing coverage: codes, telehealth and who can bill
The short answerMedicare pays for psychological and neuropsychological testing (96130 to 96139, 96146) under the diagnostic tests benefit, not as incident to. Clinical psychologists, independent psychologists, NPs, CNSs and PAs can bill. Which indications and hours are accepted depends on your MAC's LCD.
By Javier Alvarez · Updated · 1 min read
1 row: Medicare. Public policy, not the member's benefits.
Medicare (national)
Original Medicare Part B, Physician Fee Schedule and Benefit Policy Manual · All states
| 96116 | Listed (neurobehavioral status exam, first hour (active on the 2026 PFS)) [1] |
|---|---|
| 96121 | Listed (add-on, each additional hour (active on the 2026 PFS)) [1] |
| 96130 | Listed (psychological testing evaluation, first hour (active on the 2026 PFS)) [1] |
| 96131 | Listed (add-on, each additional hour (active on the 2026 PFS)) [1] |
| 96132 | Listed (neuropsychological testing evaluation, first hour (active on the 2026 PFS)) [1] |
| 96133 | Listed (add-on, each additional hour (active on the 2026 PFS)) [1] |
| 96136 | Listed (test administration and scoring by the clinician, first 30 minutes (active on the 2026 PFS)) [1] |
| 96137 | Listed (add-on, each additional 30 minutes (active on the 2026 PFS)) [1] |
| 96138 | Listed (test administration and scoring by a technician, first 30 minutes (active on the 2026 PFS)) [1] |
| 96139 | Listed (add-on, technician, each additional 30 minutes (active on the 2026 PFS)) [1] |
| 96146 | Listed (single automated instrument, automated result only (active on the 2026 PFS)) [1] |
| Where it applies | Testing is paid as a diagnostic test under section 1861(s)(3) of the Social Security Act. Incident to billing is not authorized for these tests. Diagnostic testing is outside the outpatient mental health treatment limitation. [2] |
| Telehealth rules | Codes 96116, 96121, 96125, 96130 to 96133 and 96136 to 96139 are on the CY 2026 final list of Medicare telehealth services. We did not find 96146 on that list. Through December 31, 2027, patients can receive Medicare telehealth services anywhere in the United States and territories. [3][4] |
| Who can bill | Clinical psychologists, independently practicing psychologists (with a physician order), NPs, CNSs and PAs within state scope, and physicians. A psychologist on an institution's staff does not bill; the institution does. An independent psychologist who is not a clinical psychologist must put the ordering physician's name and address on the claim. [2] |
| Payment | 2026 national payment computed from the published RVUs times the $33.4009 conversion factor (non-QPP file), non-facility rate: 96130 $123.92, 96131 $86.51, 96132 $122.25, 96133 $97.86, 96136 $43.76, 96137 $37.07, 96138 $37.74, 96139 $35.40, 96146 $2.34. Facility rates for 96130, 96132 and 96136 are $99.53, $98.53 and $21.38. Local rates vary by GPCI. [1] |
| Also | The manual says there is no payment under the fee schedule for services performed by students or trainees. A trainee being present while a licensed clinician tests does not stop the clinician from billing. The manual text still names the pre 2019 code numbers. [2] |
- CMS: CY 2026 Physician Fee Schedule relative value file RVU26D (PPRRVU2026_Oct_nonQPP.csv, conversion factor 33.4009), checked October 30, 2026
- CMS: Medicare Benefit Policy Manual (100-02) Chapter 15, section 80.2 Psychological Tests and Neuropsychological Tests, checked October 30, 2026
- CMS: List of Telehealth Services, CY 2026 PFS final list, checked October 30, 2026
- CMS: Telehealth FAQ (updated 10/8/26), checked October 30, 2026
What Medicare (national)'s documents say
The table above has every field we found for Medicare (national), with numbered sources. In short:
- Who can bill. Clinical psychologists, independently practicing psychologists (with a physician order), NPs, CNSs and PAs within state scope, and physicians. A psychologist on an institution's staff does not bill; the institution does. An independent psychologist who is not a clinical psychologist must put the ordering physician's name and address on the claim.
- Telehealth rules. Codes 96116, 96121, 96125, 96130 to 96133 and 96136 to 96139 are on the CY 2026 final list of Medicare telehealth services. We did not find 96146 on that list. Through December 31, 2027, patients can receive Medicare telehealth services anywhere in the United States and territories.
- Where it applies. Testing is paid as a diagnostic test under section 1861(s)(3) of the Social Security Act. Incident to billing is not authorized for these tests. Diagnostic testing is outside the outpatient mental health treatment limitation.
- Codes. 96116, 96121, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139 and 96146 are listed.
Codes we checked at Medicare (national)
What Medicare's own text says about one code: 96130, 96132, 96136, 96138 and 96146.
Psychological testing coverage at other national payers
Aetna, UnitedHealthcare and Optum Behavioral, Cigna and Evernorth and Carelon Behavioral Health.
Check Medicare (national)'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 with every other payer we checked.