96130 with UnitedHealthcare and Optum Behavioral: what the policy says
The short answerBillable, but expect prior authorization. Optum's commercial list requires PA for 96130 and 96131, and bill only one unit of 96130 per testing episode. Do not pair it with 96132 or 96133 in the same episode.
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 policy says about 96130
96130 is the CPT code for psychological testing evaluation services, first hour. At UnitedHealthcare and Optum Behavioral it is limited: paid only in a narrow case, see the note. Each line below is from the cited text:
- Billed with. Do not bill 96130/96131 with 96132/96133 in one episode. An evaluation code cannot be billed without test administration and scoring codes (96136/96137 or 96138/96139). (Optum, checked October 30, 2026)
- Units. 96130 is a base code, billed one unit only per testing episode, even when testing runs over several days. Extra hours go on 96131. (Optum, checked October 30, 2026)
- Prior authorization. 96130 and 96131 are on Optum's commercial prior authorization list. On UnitedHealthcare Exchange plans in Colorado (2026), authorization is only required if an administration and scoring code is submitted with 96130 and 96131. (Optum, checked October 30, 2026; UnitedHealthcare, checked October 30, 2026)
96130 at other payers
- 96130 with Medicare (national): listed.
- 96130 with Washington Apple Health: limited.
- 96130 with South Carolina Medicaid (RBHS): limited.
- 96130 with Nevada Medicaid: listed.
The rest of UnitedHealthcare and Optum Behavioral's psychological testing rules
The UnitedHealthcare and Optum Behavioral row has its codes, telehealth rule, limits and authorization, each with its source. Other codes we checked at UnitedHealthcare and Optum Behavioral: 96136 and 96146. Before the claim goes out, compare it with the row in the table above.