CPT 96138: Technician Psychological/Neuropsychological Test Administration and Scoring
Medicare pays $40 and commercial payers pay $189 on average nationally for this procedure.
CPT code 96138 describes a technician-administered psychological or neuropsychological testing service in which two or more tests are administered and scored, reported for the first 30 minutes of administration and scoring by any method; typical service type is test administration and scoring by technician, commonly performed in outpatient behavioral health or neuropsychology clinic settings.
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 rate of $39.5 sits well below BUCA’s average commercial mean of $188.7, indicating a sizable gap between public and that commercial benchmark for CPT 96138. That gap of $149.2 highlights how commercial reimbursement can be multiple times higher than Medicare for this behavioral assessment code, with Medicare values clustered (median $39, P25 $36, P75 $41) compared with the broader commercial average.
Dispersion measured as P75 minus P25 is narrowest for Aetna at $13.6 and for Medicare at $5, reflecting tight clustering around their central tendencies. The widest dispersion appears with Blue Cross Blue Shield at $48.9 and BUCA at $38.5, signaling substantial variability among commercial contracts; UnitedHealth Group ($35.2) and Cigna ($24.9) fall in between. These ranges illustrate where payers exhibit consistent versus highly variable payment behavior for this CPT.