CPT 96137: Psychological/Neuropsychological Test Admin & Scoring, addl 30 min
Medicare pays $39 and commercial payers pay $44 on average nationally for this procedure.
CPT code 96137 describes a physician or other qualified healthcare professional administering and scoring two or more psychological or neuropsychological tests, with services that require an additional 30 minutes beyond the initial 30 minutes; this represents psychological/neuropsychological test administration and scoring typically provided in an outpatient behavioral health or neuropsychology clinic setting or a similar ambulatory care site of service.
For related coverage guidance, see recent payer policy updates: Lumbar Microdiscectomy, Artificial Cervical Intervertebral Disc, Lumbar Decompression.
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National Reimbursement Benchmarks
Nationally, Medicare averages $38.6 for CPT 96137 while BUCA’s average commercial rate sits higher at $43.8, indicating commercial payment levels above Medicare by about $5.2 on average. Blue Cross Blue Shield ($33.7 mean) and Aetna ($62.5 mean) bracket the commercial spectrum, with UnitedHealth Group showing the highest commercial mean at $54.8 and Cigna at $44.8.
Dispersion measured as the interquartile spread (P75 minus P25) is tightest for Blue Cross Blue Shield at $18.5 and for Aetna at $27.9, while UnitedHealth Group and Cigna display wider spreads of $36.5 and $28.4 respectively, indicating more variability in allowed amounts among those carriers. BUCA’s IQR is $24.7 and Medicare’s IQR is $4, reflecting very localized consistency across Medicare localities.