Summary & Overview
CPT 96130: Psychological Testing Evaluation Services
CPT code 96130 represents psychological testing evaluation services, a critical component in the assessment and management of mental health and neurodevelopmental disorders. This code covers the comprehensive evaluation process, including the integration of patient data, interpretation of standardized test results, clinical decision making, treatment planning, and interactive feedback to patients and their families. The service is typically performed in an office setting by physicians, psychologists, or other qualified health care professionals.
Nationally, psychological testing evaluation is recognized by major payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. Coverage for this service is essential for ensuring access to accurate diagnosis and effective treatment planning for conditions such as major depressive disorder, generalized anxiety disorder, autism spectrum disorder, and attention-deficit hyperactivity disorder.
Readers will gain insight into the clinical context of psychological testing evaluation, current policy updates, and reimbursement benchmarks for CPT code 96130. The publication also addresses relevant modifiers, associated provider taxonomies, and common ICD-10 diagnoses linked to this service. Understanding these elements is vital for stakeholders navigating the evolving landscape of mental health services and medical billing.
CPT Code Overview
CPT code 96130 is used to report psychological testing evaluation services performed by a physician or other qualified health care professional. This service includes the integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning, and the preparation of a report. Additionally, interactive feedback is provided to the patient, family members, or caregivers when performed. The typical site of service for this procedure is the office setting (Place of Service 11). Psychological and neuropsychological testing evaluation services are essential for diagnosing and managing a range of mental health and neurodevelopmental conditions.
Clinical & Coding Specifications
Clinical Context
A patient presents to the office (Place of Service 11) with concerns related to mood, attention, or behavior. The provider, such as a psychologist, psychiatry physician, or mental health counselor, conducts a comprehensive psychological evaluation. This includes integrating patient history, interpreting standardized test results, making clinical decisions, planning treatment, and providing interactive feedback to the patient and their family or caregivers. The evaluation may be prompted by symptoms of major depressive disorder, generalized anxiety disorder, autism spectrum disorder, attention-deficit hyperactivity disorder, or attention and concentration deficits.
Coding Specifications
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Modifiers:
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26: Professional Component. Used when only the professional service (interpretation and report) is provided, not the technical component. - Modifier
59: Distinct Procedural Service. Used to indicate that psychological testing evaluation is a separate and distinct service from other procedures performed on the same day.
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Provider Taxonomies:
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