UnitedHealthcare and Optum Behavioral psychological testing coverage: codes, limits and prior authorization
The short answerFor UnitedHealthcare behavioral benefits (Optum), bill each base code once per testing episode (96130 or 96132, plus 96136 or 96138) and use add-on codes for more time, even across days. Commercial plans list 96130, 96131 and 96136 to 96139 for prior authorization; 96132 and 96133 are not on that list.
By Javier Alvarez · Updated · 1 min read
1 row: UnitedHealthcare (Optum). Public policy, not the member's benefits.
UnitedHealthcare and Optum Behavioral
Optum reimbursement policy 2019RP501A, commercial prior authorization code list, Colorado Exchange list · All states
| 96130 | Listed (on the Optum commercial prior authorization list) [1] |
|---|---|
| 96131 | Listed (on the Optum commercial prior authorization list) [1] |
| 96132 | Not named (billable per the reimbursement policy; not on the commercial prior authorization list) [2][1] |
| 96133 | Not named (billable per the reimbursement policy; not on the commercial prior authorization list) [2][1] |
| 96136 | Listed (on the Optum commercial prior authorization list) [1] |
| 96137 | Listed (on the Optum commercial prior authorization list) [1] |
| 96138 | Listed (on the Optum commercial prior authorization list) [1] |
| 96139 | Listed (on the Optum commercial prior authorization list) [1] |
| 96146 | Limited (standalone only, for one computerized measure and no other measures) [2] |
| Visit limits | Base codes (96130, 96132, 96136, 96138) are billed one unit only per testing episode, even when testing spans several days. Later time goes on the add-on codes (96131, 96133, 96137, 96139). The single bill is submitted when the episode concludes with the evaluation report. [2] |
| Prior authorization | Optum's commercial list requires prior authorization for 96130, 96131 and 96136 to 96139. On UnitedHealthcare Exchange plans in Colorado (2026), authorization is only required if the administration and scoring code is submitted with 96130 and 96131. Check the member's state and product list. [1][3] |
| Also | Evaluation codes cannot be billed without test administration and scoring codes: a complete episode includes both series. Do not bill psychological (96130, 96131) and neuropsychological (96132, 96133) evaluation codes in the same episode; choose the one that matches the predominant service. Optum follows the APA billing and coding guide. [2] |
- Optum: Commercial Prior Authorization Code List BH01532-1-25 (09/26/2025), checked October 30, 2026
- Optum: Psychological and Neuropsychological Testing Reimbursement Policy 2019RP501A (copyright 2026), checked October 30, 2026
- UnitedHealthcare: Prior Authorization Code List, Exchange Plans in Colorado, behavioral health (effective 1/1/2026), checked October 30, 2026
What UnitedHealthcare and Optum Behavioral's documents say
The table above has every field we found for UnitedHealthcare and Optum Behavioral, with numbered sources. In short:
- Prior authorization. Optum's commercial list requires prior authorization for 96130, 96131 and 96136 to 96139. On UnitedHealthcare Exchange plans in Colorado (2026), authorization is only required if the administration and scoring code is submitted with 96130 and 96131. Check the member's state and product list.
- Visit limits. Base codes (96130, 96132, 96136, 96138) are billed one unit only per testing episode, even when testing spans several days. Later time goes on the add-on codes (96131, 96133, 96137, 96139). The single bill is submitted when the episode concludes with the evaluation report.
- Codes. 96130, 96131, 96136, 96137, 96138 and 96139 are listed. 96132 and 96133 are not named in this policy. 96146 is limited.
Codes we checked at UnitedHealthcare and Optum Behavioral
What UnitedHealthcare (Optum)'s own text says about one code: 96130, 96136 and 96146.
Psychological testing coverage at other national payers
Medicare (national), Aetna, Cigna and Evernorth and Carelon Behavioral Health.
Check UnitedHealthcare and Optum Behavioral'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 UnitedHealthcare (Optum) with every other payer we checked.