CPT 96131: Psychological Testing, Each Additional Hour
Medicare pays $89 and commercial payers pay $112 on average nationally for this procedure.
CPT code 96131 describes an additional hour of psychological testing and evaluation services in which a physician or qualified healthcare professional administers standardized psychological tests, interprets results, establishes a treatment plan, and prepares a report; this service is typically provided as psychological testing/evaluation in outpatient behavioral health or specialty clinic settings and is billed in addition to the first hour (96130).
For related coverage guidance, see recent payer policy updates: Lumbar Microdiscectomy, Artificial Cervical Intervertebral Disc, Lumbar Decompression.
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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.