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CPT 96130: Psychological Testing, Interpretation and Treatment Planning (First Hour)
CPT code 96130 represents the first-hour physician or qualified healthcare professional service for standardized psychological testing, including administration, interpretation, treatment planning, and report preparation with discussion of results. This code is a key billing category for behavioral health services that require structured assessment tools and documented interpretation. Nationally, accurate use of 96130 affects care coordination, clinical documentation, and appropriate payment for time-intensive diagnostic evaluation in mental health settings.
Key payers covered in this summary include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code's clinical scope and service settings, comparisons to closely related assessment codes, common billing considerations, and typical diagnostic contexts where the code is used (for example, depressive and anxiety disorders, autism spectrum disorder, and attention-deficit disorders). The publication outlines policy and coding guidance relevant to nationwide billing practice, concise benchmarks for service definition and reporting, and practical distinctions between 96130 and related neurobehavioral or assessment codes. This material is intended to clarify the purpose of the code, inform billing accuracy, and situate the service within broader behavioral health evaluation workflows.
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Billing Code Overview
CPT code 96130 describes a standardized psychological testing service provided by a physician or other qualified healthcare professional. The service covers administration and interpretation of standardized psychological tests, development of a treatment plan, and preparation of a written report for the first hour of service. The description also specifies discussion of results and the treatment plan with the patient and family member(s) or caregiver(s), when performed.
Service type: Psychological testing and evaluation, including interpretation and treatment planning
Typical site of service: Behavioral health clinics, outpatient mental health centers, hospital outpatient departments, and physician offices
National Reimbursement Benchmarks
Medicare’s mean reimbursement of $127.4 for CPT 96130 sits below BUCA’s average commercial mean of $261.6, indicating commercial payers on average reimburse roughly $134 higher than Medicare for this code. BUCA’s mean positions it near the middle of the commercial range represented by other carriers, while Blue Cross Blue Shield’s mean ($340.8) and UnitedHealth Group’s mean ($183.1) show notable variation across major carriers.
Dispersion measured by the interquartile range (P75–P25) highlights where rates are tightest and widest: Aetna’s IQR is $31.0, Cigna’s is $78.7, UnitedHealth Group’s is $103.8, BUCA’s is $74.4, and Blue Cross Blue Shield’s is $75.6. The tightest spread is with Aetna ($31.0) and the widest is with UnitedHealth Group ($103.8), illustrating meaningful differences in contract variability among payers.