CPT 96130: Psychological Testing, Interpretation, Treatment Plan
Medicare pays $127 and commercial payers pay $262 on average nationally for this procedure.
CPT code 96130 describes a clinician-administered standardized psychological testing service that includes test administration, interpretation of results, formulation of a treatment plan, and preparation of a written report for the first hour; the service is typically performed by a psychologist or other qualified behavioral health professional in an outpatient behavioral health or clinic setting and includes discussion of results and the treatment plan with the patient and family or caregivers when provided.
For related coverage guidance, see recent payer policy updates: Lumbar Microdiscectomy, Artificial Cervical Intervertebral Disc, Lumbar Decompression.
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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.