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CPT 96131: Psychological Testing, Each Additional Hour
CPT code 96131 covers each additional hour of psychological testing, interpretation, treatment planning, and reporting provided by a physician or other qualified healthcare professional after the initial hour billed with 96130. This code matters nationally because standardized psychological and neuropsychological testing is essential for diagnostic clarity and treatment planning for cognitive, behavioral, and neuropsychiatric conditions, and proper billing ensures recognition of lengthy, resource-intensive evaluation work.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise overview of what the code represents, common clinical contexts in which it is used, and the associated service settings. The publication outlines payer coverage considerations, commonly applied modifiers, relevant provider taxonomies, typical ICD-10 diagnostic contexts, and closely related codes such as 96130 for the first hour. It also summarizes practical billing elements: when to report 96131 (each additional hour), the link to the primary code 96130, and typical documentation expectations tied to test administration, interpretation, and reporting.
This summary is designed for clinicians, billing professionals, and policy analysts seeking a clear, national-level reference for coding and clinical context of extended psychological testing services.
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Billing Code Overview
CPT code 96131 describes additional hours of psychological testing and evaluation provided by a physician or other qualified healthcare professional. The service includes administration of standardized psychological tests, interpretation of test results, development of a treatment plan, and preparation of a written report for each additional hour beyond the first hour billed with the primary code 96130.
Service type: Psychological and neuropsychological testing evaluation services (additional hours)
Typical site of service: Outpatient behavioral health clinics, neuropsychology practices, psychiatric offices, and other ambulatory care settings where standardized psychological testing and evaluation are performed.
National Reimbursement Benchmarks
Across payers, Medicare's mean of $89.2 sits below BUCA's average commercial mean of $112.2, indicating Medicare reimbursement for CPT 96131 is roughly $23 lower on a national basis. This gap highlights commercial payers generally paying more than Medicare for this code, with UnitedHealth Group and Cigna showing the highest mean levels among the listed commercial plans.
Dispersion measured as the interquartile range (P75–P25) is narrowest for Medicare at $4 (P75 $90 minus P25 $86), indicating very tight geographic variation across localities. Blue Cross Blue Shield and Aetna have relatively small spreads of $40.8 (BCBS P75 $119.4 minus P25 $80.6) and $27.2 (Aetna P75 $99.9 minus P25 $72.7), respectively, while UnitedHealth Group ($81.6) and Cigna ($60.0) show the widest IQRs, reflecting greater variability among commercial contracts.