CurrentBlue Cross Blue Shield - TexasPolicy CPCPOO8

Psychological and Neuropsychological Testing

Governs coding and payment for psychological and neuropsychological testing provided to Blue Cross and Blue Shield of Texas members, including provider responsibilities, billing guidance, and an appendix catalog of tests.

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyPsychological and Neuropsychological Testing

Policy CodePolicy CPCPOO8

Change TypeNo material changes

Effective DateFeb 13, 2025

Next Review DateFeb 13, 2025

Key ActionEstablish medical necessity per PSY 301.020 before performing psychological or neuropsychological testing.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

once/yrtesting limit frequency

8hneuropsych evaluation time

3-4hpsych testing time (typical)

16mmin for 30-min code

31mmin for per-hour code

yes

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age/time details included

Coverage Criteria and Appendix Guidance

Coverage of psychological and neuropsychological testing is conditional on provider qualifications, test type, coding/billing rules, and demonstrated medical necessity. The following criteria and billing guidance consolidate Appendix A usage notes and policy rules that apply to test administration, scoring, reporting, and claim submission.

ALL of the following

Services must be provided or overseen by a medical or mental health provider licensed in their state of practice who is qualified to administer, score, and interpret psychological testing. Individuals working or training under supervision are technicians and may not bill Qualified Healthcare Professional (QHP)-only codes independently.
Preserve documentation of licensure, training, and supervisory relationship in the medical record.
Medical necessity as defined by the Psychological and Neuropsychological Testing Policy (PSY 301.020) must be established prior to testing. Testing that is solely brief symptom inventories or screening tools does not meet criteria for comprehensive testing and should be billed with brief assessment or automated testing CPT codes when appropriate.
Testing limited to monitoring or brief screening during routine therapy may not qualify for comprehensive testing codes.
Only standardized tests based on published national normative data that produce standardized or scaled scores qualify for reimbursement. Appendix A is a catalog guidance tool — it is not exhaustive; other covered tests may exist but still require medical necessity documentation.
Use Appendix A timing estimates for administration and scoring as an operational guide; do not substitute for clinical judgment.
Claims should be submitted only after completion of all testing-related services in the testing episode (pre-assessment planning; administration; scoring; integration of data; report write-up; feedback). If testing spans multiple days, submit the claim at the conclusion of the entire service episode.
Base codes are used once per testing episode; do not bill base codes multiple times across days for the same episode.
Psychological and neuropsychological testing is limited to once per calendar year. More than one testing claim in a year may be subject to medical record and medical necessity review unless clinically justified.
Document rationale for repeat testing and obtain preauthorization if required.
Time-based CPT testing codes require minimum documented face-to-face time: a minimum of 16 minutes to report a 30-minute code, and a minimum of 31 minutes to report any per-hour code. Do not bill time-based testing codes concurrently with other time-based psychotherapy codes for the same time period; if a therapy session includes only a brief inventory, bill the therapy code plus an appropriate brief assessment code rather than an additional 30- or 60-minute testing code.
Ensure time documentation is specific and unambiguous in the chart.
Psychological and neuropsychological testing base codes (e.g., 96112, 96116, 96130, 96132, 96136, 96138 and their add-on counterparts) may be used only once per testing episode. When a comprehensive evaluation is performed, bill the set of codes consistent with whether the evaluation is psychological or neuropsychological; do not bill both categories for the same predominating evaluation.
Use add-on codes (EA) only as appropriate and with the corresponding primary base code.
CPT codes 96130-96133 and 96136-96139 are intended for comprehensive assessments and should not be used for brief screenings or routine progress monitoring during therapy or psychiatric follow-up visits. CPT codes 96130-96133 may be billed only by a QHP who is independently licensed and contracted with the plan.
Technicians cannot bill QHP-only codes; ensure billing provider credentials match code requirements.
Only tests listed in Appendix A that meet the standardized test requirement are acceptable as guidance; Appendix A entries include typical administration+scoring timeframes to assist providers planning testing services. The appendix may include screening instruments (short inventories) with shorter timeframes — these shorter tools generally should be billed with brief assessment/automated testing codes, not comprehensive testing codes.
Appendix A is a catalog — inclusion does not by itself establish medical necessity or coverage.

Appendix A usage and constraints

Appendix A is provided as a catalog and timing reference for commonly used psychological and neuropsychological instruments. It is intended to aid test selection and to provide estimated administration plus scoring times used when planning services and validating billed time-based codes.

ALL of the following

Appendix A lists tests with typical age ranges and estimated administration/scoring times; these estimates were calculated using Tests in Print and test publisher guidelines and are intended only as operational guidance.
Use the specific test manual/publisher guidance when available; recorded times in Appendix A are approximations.
Instruments in Appendix A that are very brief (e.g., 5-15 minutes) are generally screening or inventory tools and do not justify comprehensive testing CPT codes. Bill such instruments using brief assessment or automated testing CPT codes as clinically appropriate.
When multiple brief inventories are combined into a single testing episode, ensure total time and clinical integration meet criteria for comprehensive testing before billing comprehensive codes.
Inclusion of a test in Appendix A does not guarantee coverage. Medical necessity documentation per the policy and plan requirements must accompany testing claims when requested.

Coverage-related notes from Appendix A

Operational rules and billing notes to reduce claim denials and ensure correct code usage.

ALL of the following

Submit claims only after all testing activities for the episode are complete; do not split base code use across multiple claims for the same episode. Base codes should be used one time per testing episode even if administration occurs over multiple days.
If testing spans multiple days, submit a single comprehensive claim at episode completion.
If a therapy session includes administration of a brief inventory (e.g., Beck Depression Inventory) within a standard therapy visit and the total time does not exceed the therapy duration threshold, do not bill an additional 30- or 60-minute testing code. Instead, bill the therapy service and an appropriate brief behavioral assessment code if applicable.
Avoid double-billing overlapping face-to-face time between psychotherapy and time-based testing codes.
Maintain documentation of test administration, scoring, integration, report write-up, and feedback. Records must support billed time, test selection, norms used, and interpretation. Lack of adequate documentation increases denial risk.
Retain test protocols, score sheets, and final integrated report in the medical record.

appendix_a_usage

Key billing and denial-risk callouts for providers.

ALL of the following

Prior authorization may be required when testing exceeds typical annual limits or when repeat testing within the same calendar year is requested.
Obtain preauthorization where required by the member’s benefit plan.
Billing Rule: Time-based testing CPTs require documented minutes meeting minimum thresholds (e.g., 16 minutes for 30-minute code; 31+ minutes for per-hour codes).
Do not report time-based testing codes for periods that overlap with psychotherapy time billed to the same date/time.
Denial Risk: Multiple claims for testing within one calendar year without clear medical necessity documentation are likely to trigger medical records review or denial.
When repeat testing is clinically indicated within a year, document the specific change in clinical status or reason for repeat assessment.

CPT/HCPCS Codes, Time Rules, and Test Catalog

Psychological and neuropsychological testing CPT codesCPTCovered

96105	Assessment of aphasia and cognitive performance testing / developmental screening (per table guidance)
96110	Developmental screening (WISC score reference); for emotional/behavioral assessment use 96127
96112	Developmental testing by physician/QHP first hour
96113	Developmental testing each additional hour (add-on)
96116	Neurobehavioral status exam first hour
96121	Neurobehavioral status exam each additional hour (add-on)
96130	Psychological testing evaluation by physician/QHP first unit
96131	Psychological testing evaluation each additional unit (add-on)
96132	Neuropsychological testing evaluation by physician/QHP first unit
96133	Neuropsychological testing evaluation each additional unit (add-on)

1–10 of 16

1/2

Test catalog entries (no CPT/HCPCS codes provided in this excerpt)mixed

No codes listed

Test catalog (no billing codes provided in these chunks)mixed

No codes listed

test_catalog_codesmixed

No codes listed

test_catalog_entriesmixed

No codes listed

Coding referencesCPT

CPT reference

Document references Current Procedural Terminology (CPT) guidance for coding (AMA, 2023).

Use of base codes per testing episode

RulePsychological and neuropsychological testing base codes (96112, 96116, 96130, 96132, 96136, 96138) may be used only once per testing episode; if testing spans multiple days the base code should be used only once at the start of the service episode.

Multi-day claimsIf testing takes place across multiple days, submit the claim at the conclusion of all services (claim submitted upon completion of all testing-related services).

Add-on unitsAdd-on codes (e.g., 96113, 96121, 96131, 96133, 96137, 96139) may be reported for additional hours/units as appropriate; base code limitation still applies.

Time-based billing minima

30-minute code minimum

Provider Responsibilities and Prior Authorization

Billing Rule

Claim Submission Timing

Providers must submit claims only after completion of all testing-related services for the episode. This includes pre-assessment planning; test administration and scoring; integration of data; report write-up; and any feedback session. If testing occurs across multiple days, submit the claim at the conclusion of the entire testing episode. Psychological and neuropsychological testing is limited to once per calendar year unless additional testing is supported by medical records and medical necessity review.

Submit one claim at end of testing episode (includes multi-day testing).
Testing limited to once per calendar year unless medical necessity documented.

Documentation Required

Provider Qualifications and Billing Rules

Provider qualifications and billing rules: Testing services must be provided or overseen by medical or mental health providers licensed in their state of practice who are qualified to administer, score, and interpret psychological testing. CPT codes 96130–96133 (test evaluation) may be billed only by a Qualified Healthcare Professional (QHP) who is independently licensed and contracted with the plan; personnel working or training under supervision are considered technicians and may only bill technician codes where appropriate. Base testing codes (96112, 96116, 96130, 96132, 96136, 96138) may be used only once per testing episode; if testing spans multiple days, the base code is billed once at the start of the episode. Providers should not bill both psychological and neuropsychological evaluation codes for the same episode — bill for the predominant evaluation type.

Definitions and Test Entry Format

Plan documents

Definition'Plan documents' include Certificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions, and other coverage documents.

PrecedenceWhen a conflict arises between this Clinical Payment and Coding Policy and a member's plan document, the plan document will govern.

Provider contractsIf a conflict arises between this policy and a provider contract, the provider contract will govern.

Qualified Healthcare Professional (QHP)

QHP definitionQualified Healthcare Professional (QHP) is an independently licensed and contracted provider who may bill CPT codes 96130–96133 for comprehensive testing.

Technician statusIndividuals working or training under the supervision of a QHP are considered technicians and do not bill QHP-only evaluation codes.

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyPsychological and Neuropsychological Testing

Policy CodePolicy CPCPOO8

Change TypeNo material changes

Effective DateFeb 13, 2025

Next Review DateFeb 13, 2025

Key ActionEstablish medical necessity per PSY 301.020 before performing psychological or neuropsychological testing.

SourceLink

On This Page

Providers should be prepared to supply test choice rationale, scoring/integration, and report documentation for medical necessity review.

When a test battery or full evaluation has an expected timeframe (for example, neuropsychological evaluations ~8 hours), use these estimates to support appropriate selection of codes and expected billing intensity. Shorter batteries (e.g., readiness for bariatric surgery ~3–4 hours) have correspondingly lower expected timeframes.

If billed time substantially exceeds Appendix A estimates, include documentation explaining the clinical reasons for extended testing time.

Providers should confirm credentialing and contracting status for billing QHP-only codes (96130-96133). Technicians and supervised trainees may provide services but cannot bill those QHP-only codes independently.

Ensure billing provider taxonomy and NPI match the required provider type for the billed codes.

A minimum of 16 minutes must be provided to report a 30-minute code.

Per-hour code minimumA minimum of 31 minutes must be provided to report any per-hour code.

Concurrent time-based billingTime-based CPT codes should not be billed concurrently with other time-based therapy codes unless testing time exceeded the therapy session duration.

Time estimates included

Inclusive times providedMany Appendix A entries include approximate administration and scoring times (e.g., 5–90 minutes) to guide billing and scheduling.

Source of estimatesTest administration and scoring times were calculated using Tests in Print guidelines and test publisher's guidelines.

Format noteTime values in Appendix A are presented as part of the test entry fields (Test Name, Age/Type, Time inclusive of administration and scoring).

Typical administration/scoring time

Range of durationsTypical administration and scoring times vary widely by test (examples in Appendix A range from ~5 minutes to 90+ minutes; some batteries up to several hours).

ExamplesExamples include CTOPP-2 subtests: 30 min (subtests 10 min each), D-KEFS full battery: 90 minutes, RBANS: 30 minutes, Raven's SPM: 45 minutes.

Use for planningProviders should use the listed administration+scoring times to estimate total testing episode duration and support coding choices.

Only independently licensed QHPs contracted with the plan may bill 96130–96133.
Technicians (trainees/supervised staff) cannot bill QHP test evaluation codes; use technician codes where appropriate.
Base testing codes billed once per episode; do not repeat base code across multi-day testing.
Do not bill both psychological and neuropsychological evaluation codes for the same evaluation episode.

Prior Authorization

Prior Authorization / Medical Necessity Requirement

Medical necessity as defined in PSY 301.020 must be established prior to testing. Only standardized tests with published national normative data that produce standardized or scaled scores qualify for reimbursement. Brief screening tools or brief symptom inventories do not qualify as comprehensive psychological testing and should be billed with appropriate brief assessment or automated testing CPT codes instead. Time-based CPT codes must reflect actual time thresholds (e.g., minimum minutes for 30‑minute and per-hour codes); time-based testing codes should not be billed concurrently with other time-based therapy codes if the combined time does not meet thresholds.

Establish medical necessity per PSY 301.020 before testing.
Only standardized tests with normative data and standardized/scaled scoring are reimbursable.
Use brief assessment or automated testing CPT codes for screening/brief inventories.
Do not double-bill time-based testing codes with therapy codes unless time thresholds are independently met.

Billing restrictionCPT codes 96130–96133 may only be billed by a QHP who is independently licensed and contracted with the plan.

Standardized tests qualifying for reimbursement

EligibilityOnly standardized tests based on published national normative data with scoring that yields standardized or scaled scores qualify for reimbursement.

ExclusionBrief symptom inventories or screening tests alone do not qualify as comprehensive psychological testing and should use brief assessment or automated testing CPT codes (e.g., 96127, 96146).

DocumentationProviders should ensure tests meet the standardized/normative requirement when submitting claims for reimbursement.

Inclusive administration and scoring time estimates

Inclusive time estimatesAppendix A provides administration and scoring time estimates for each test entry; these times are inclusive of both administration and scoring.

Calculation basisTimes were calculated using Tests in Print guidelines and test publisher's guidelines.

PurposeTimes are listed to aid providers in planning testing episodes and supporting coding decisions.

Format: Test Name, Acronym, Age/Type, Time

Entry fieldsFormat for each test entry: Test Name, 1 = Acronym; 2 = Type/Construct; 3 = Age; 4 = Time (inclusive of administration and scoring).

Consistent presentationAppendix A entries follow the Test Name / Acronym / Age / Time format to standardize guidance across tests.

Provider useUse the formatted fields to identify appropriate tests by age, type, and expected duration.

Appendix A test entry format

Appendix A formatAppendix A test entry format lists: Test Name; 1 = Acronym; 2 = Type/Construct; 3 = Age; 4 = Time (inclusive of administration and scoring).

Guidance noteAppendix A is intended as an aid; it may not include all covered tests—medical necessity per PSY 301.020 still applies.

Time sourceAdministration and scoring times in Appendix A were calculated from Tests in Print and test publisher guidelines.

administration/scoring time

DefinitionAdministration/scoring time is the estimated inclusive duration for administering and scoring each test as listed in Appendix A.

Calculation basisEstimates were calculated using established Tests in Print guidelines and test publisher's guidelines.

Use for codingProviders should use these inclusive times when determining appropriate time-based CPT code reporting and episode planning.

medical necessity

RequirementAll testing must meet medical necessity as defined by the Psychological and Neuropsychological Testing Policy (PSY 301.020) before being performed.

Prior to testingMedical necessity must be established prior to testing; claims may be subject to medical necessity review if multiple tests are performed within a year.

Reference policySee PSY 301.020 for the medical necessity criteria applicable to psychological and neuropsychological testing.

test_entry_format

Presentation formatTest entries are presented with Name, Acronym, Type/Construct, Age range, and Time (administration + scoring).

ExamplesEntries such as BRIEF-P (15 min), CTOPP-2 subtests (10 min each; 30 min whole), and Raven's CPM (up to 30 min) illustrate the format.

Provider useThe format helps quickly identify test purpose, applicable ages, and expected time commitment for coding and scheduling.

Presentation format for test entries

Display orderAppendix entries are displayed as: Test Name; 1 = Acronym; 2 = Type/Construct; 3 = Age; 4 = Time (inclusive of administration and scoring).

NotesEach entry repeats the guide notice that Appendix A is an aid and that medical necessity per PSY 301.020 is required prior to testing.

Time sourcingTimes are noted as calculated from Tests in Print and publishers' guidelines to standardize estimates across entries.

Calculated using Tests in Print and publishers' guidelines

Calculation methodAdministration and scoring times were calculated using established Tests in Print guidelines and test publisher's guidelines.

PurposeThese calculations produce the inclusive time estimates shown in Appendix A to inform billing and scheduling.

Provider guidanceUse publisher guidance and Tests in Print benchmarks when preparing documentation to support billed testing times.