96136 with UnitedHealthcare and Optum Behavioral: what the policy says
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 96136
96136 is the CPT code for psychological or neuropsychological test administration and scoring by physician or QHP, first 30 minutes. 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. 96136, 96137, 96138 and 96139 may be reported with 96130, 96131, 96132 and 96133 on the same or different days. (Optum, checked October 30, 2026)
- Units. 96136 is a base code with a one unit limit per episode; each additional 30 minutes is 96137. (Optum, checked October 30, 2026)
- Prior authorization. 96136 and the other administration and scoring codes (96137 to 96139) are on Optum's commercial PA list. In the Colorado Exchange list, PA applies only when they are billed with 96130 and 96131. (Optum, checked October 30, 2026; UnitedHealthcare, checked October 30, 2026)
96136 at other payers
- 96136 with Medicare (national): 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: 96130 and 96146. Before the claim goes out, compare it with the row in the table above.