CurrentBlue KCPolicy POL-PP-261

Psychological and Neuropsychological Testing and Evaluation Services

Defines coverage, provider qualifications, coding, and billing rules for psychological and neuropsychological testing and evaluation services for Blue KC lines of business and applicable professional providers.

Policy Summary

PayerBlue KC

PolicyPsychological and Neuropsychological Testing and Evaluation Services

Policy CodePolicy POL-PP-261

Change TypeAdded provider specialtycoding correction

Effective DateNov 1, 2025

Next Review DateNov 1, 2026

Key ActionConfirm member eligibility and prior authorization with Blue KC before providing psychological or neuropsychological testing services.

SourceLink

POLICY UPDATE CHANGES

Psychiatrist added to list of providers allowed to bill psychological and neuropsychological testing.

Corrected transposed CPT code.

Initial version of the policy published with effective date and versions.

96130-96133, 96136-96139, 96127CPT codes discussed in policy

4Providers authorized to submit testing claims (listed)

Related Billing Codes

CPT-96130-PSYCHOLOGICAL-TESTING-INTERPRETATION-TREATMENT-PLAN-1HR

CPT 96130: Psychological Testing, Interpretation and Treatment Planning (First Hour)

CPT-96139-TECHNICIAN-TEST-ADMINISTRATION-SCORING-ADDITIONAL-30-MINUTES

CPT 96139: Technician Administering and Scoring Tests, Additional 30 Minutes

CPT-96133-NEUROPSYCHOLOGICAL-TESTING-ADDITIONAL-HOUR

CPT 96133: Neuropsychological Testing, Additional Hour

CPT-96131-PSYCHOLOGICAL-TESTING-ADDITIONAL-HOUR

CPT 96131: Psychological Testing, Each Additional Hour

CPT-96132-NEUROPSYCHOLOGICAL-TEST-ADMINISTRATION-UP-TO-1-HOUR

CPT 96132: Neuropsychological Test Administration, Up to 1 Hour

CPT-96136-PSYCHOLOGICAL-NEUROPSYCHOLOGICAL-TEST-ADMINISTRATION-FIRST-30-MINUTES

CPT 96136: Psychological/Neuropsychological Test Administration and Scoring, First 30 Minutes

CPT-96138-TECHNICIAN-TEST-ADMINISTRATION-SCORING-30-MINUTES

CPT 96138: Technician Administration and Scoring of Multiple Tests, First 30 Minutes

96137-PSYCHOLOGICAL-OR-NEUROPSYCHOLOGICAL-TEST-ADMINISTRATION-AND

96137 – Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; each additional 30 minutes (List separately in addition to code for primary procedure)

CPT-96127-BRIEF-EMOTIONAL-BEHAVIORAL-ASSESSMENT

CPT 96127: Brief Emotional and Behavioral Assessment

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Current policy version

Commercial & MALines of business impacted

Coverage and Medical Necessity Criteria

Medical necessity and billing criteria

Covered when ALL of the following are met

Provider qualification: Testing claims must be submitted by an authorized provider specialty: neuropsychologist, psychologist, psychiatrist, or pediatric neurodevelopmental specialist

Provider must be state-licensed to administer, score, and interpret testing

Service type: Services must be psychological or neuropsychological testing or evaluation services involving administration of standardized tests and clinical interpretation to inform diagnosis, treatment planning, or treatment evaluation

Screening for ADD/ADHD should be billed with CPT 96127 rather than psychological/neuropsychological testing codes

Supervision and administration: When a technician administers and/or scores tests (CPT 96138/96139) the supervising psychologist or qualified health care professional must provide general supervision, oversight of the data, and clinical decision making; when a psychologist/QHP personally administers and scores tests use CPT 96136/96137

First 30-minute unit codes (96136, 96138) are used only once per episode; NCCI edits may prevent billing both 96136 and 96138 on the same day for the same patient without an appropriate modifier

Use CPT 96127 for brief screening of attention-deficit disorder (ADD) and attention-deficit/hyperactivity disorder (ADHD). CPT 96127 is described as a "brief emotional/behavioral assessment (e.g., depression inventory, ADHD scale), with scoring and documentation, per standardized instrument." The policy explicitly instructs that psychological and neuropsychological testing codes should not be used for ADD/ADHD screening, and that screening must be documented with scoring and the standardized instrument used.

When reporting test administration and scoring, use the professional codes 96136/96137 if the psychologist or other qualified health care professional (QHP) personally administers and scores the tests, and the technician codes 96138/96139 when a non‑psychologist technician administers and scores under supervision. The first‑unit 30‑minute codes (96136 and 96138) are intended to be used only once per evaluation episode. Because it is common for both a professional and a technician to participate in administration/scoring, be aware that a National Correct Coding Initiative (NCCI) edit prevents billing 96136 and 96138 for the same patient on the same day without an appropriate modifier; omitting the modifier may result in claim denial or rejection.

CPT and Related Coding

Covered CPT CodesCPTCovered

96130	Psychological testing evaluation services by physician or other qualified health care professional; first hour
96131	Psychological testing evaluation services; each additional hour
96132	Neuropsychological testing evaluation services by physician or other qualified health care professional; first hour
96133	Neuropsychological testing evaluation services; each additional hour
96136	Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests; first 30 minutes
96137	Each additional 30 minutes (add-on) for physician/QHP administration and scoring
96138	Test administration and scoring by technician, two or more tests; first 30 minutes
96139	Each additional 30 minutes (add-on) for technician administration and scoring
96127	Brief emotional/behavioral assessment (e.g., depression inventory, ADHD scale) with scoring and documentation

Provider Responsibilities, Documentation, and Billing Guidance

Prior Authorization

Verify member eligibility and prior authorization

Coverage is determined by member eligibility, benefit terms, and the provider’s contract. Always verify the member’s eligibility and whether prior authorization is required with Blue KC before scheduling testing services.

Confirm eligibility and benefit limits for the date of service.
Check for any prior authorization requirements on the member’s plan; obtain prior auth when required.
Contact Blue KC Provider Hotlines for eligibility or coverage questions: Commercial: 816-395-3929; ACA: 866-859-3822; Blue Medicare Advantage: 866-508-7140.

Note

Provider action: required operational steps

Providers: ensure required documentation, licensing, and billing rules are met to avoid claim denials and reimbursement delays.

Document who performed administration/scoring (psychologist/QHP vs technician) and the supervising licensed provider.

Clinical Background

Neuropsychological assessments are standardized evaluations that measure behavioral manifestations of central nervous system (CNS) disorders using methods that aim for objectivity, validity, and reliability. Results from these assessments provide data that inform medical decisions related to diagnosis, disease course or progression, prognosis, and treatment planning. Psychological assessment more broadly involves systematically collecting reliable and valid behavioral information from multiple sources to guide diagnosis, treatment planning, or treatment evaluation. Testing must be performed or overseen by appropriately licensed providers who can interpret results and incorporate findings into clinical decision making.

Key Definitions

Technician — supervision and role summary

DefinitionTechnician: a non-psychologist/non‑QHP who may administer and score tests under general supervision; definitions vary by state and supervision, but instrument selection, interpretation, report-writing, consultation, and interactive feedback remain the responsibility of the licensed psychologist or QHP.

Supervision requiredGeneral supervision and oversight of data and clinical decision making by a state‑licensed psychologist or QHP is required when a technician administers or scores tests.

Typical responsibilitiesTechnician commonly performs test administration and may complete some scoring; final interpretation, integration of data, and reporting are the responsibility of the supervising psychologist or QHP.

State licensure noteThere is no single Medicare definition for a technician; state‑by‑state definitions and training requirements differ and the supervising licensed provider remains responsible for clinical judgment.

Billing relationshipWhen a technician is used, services are billed in combination with the corresponding evaluation service codes and must indicate supervision by the licensed psychologist or QHP.

Setting and Level of Care

Screening and Testing Modalities

Screening instruments

ADD/ADHD screening modality: Use CPT 96127 for brief emotional/behavioral screening instruments with scoring and documentation (e.g., ADHD scale); do not use psychological or neuropsychological testing codes for ADD/ADHD screening

Documentation must support use of a standardized instrument with scoring

Policy Summary

PayerBlue KC

PolicyPsychological and Neuropsychological Testing and Evaluation Services

Policy CodePolicy POL-PP-261

Change TypeAdded provider specialtycoding correction

Effective DateNov 1, 2025

Next Review DateNov 1, 2026

Key ActionConfirm member eligibility and prior authorization with Blue KC before providing psychological or neuropsychological testing services.

SourceLink

On This Page

Include standardized instrument name, scores, scoring method, interpretation, and clinical integration in the medical record.

Ensure licensure is current and the provider is authorized in their state to administer, score, and interpret tests.

Documentation Required

Required clinical documentation and provider qualifications

Maintain complete clinical documentation to support psychological/neuropsychological testing claims, including licensure and supervision details.

Clinical indication and rationale for testing, relevant history, and prior interventions.
Specific standardized instruments used, raw and scaled scores, scoring methodology, and interpretation.
Report authorship and credentials: identify the licensed psychologist, neuropsychologist, psychiatrist, or QHP who supervised or performed the testing.
If a technician performed testing, document technician role, supervision provided, and the licensed provider’s review and clinical decision-making.
Final integrated report including test results, clinical interpretation, treatment recommendations, and any feedback provided to patient/family.

Documentation Required

ADD/ADHD screening documentation (CPT 96127)

When billing CPT 96127 for ADD/ADHD screening, include documentation of the brief standardized instrument, scoring, and interpretation. Do not report psychological/neuropsychological testing codes for simple screening.

CPT 96127 requires documentation of the standardized screening instrument, score, and brief interpretation.
Do not use psychological/neuropsychological testing codes (96136–96139, 96130–96133) for ADD/ADHD screening alone.

Note

Provider qualifications, licensure, and who may submit claims

Only the listed provider specialties and appropriately licensed clinicians may submit claims for testing services; technician services must be supervised and billed per guidance.

Covered submitting specialties include: Neuropsychologist, Psychologist, Psychiatrist, Pediatric neurodevelopmental specialist.
Testing must be provided or overseen by providers licensed in the state of practice to administer, score, and interpret tests.
When a technician performs testing, the supervising licensed psychologist or QHP must provide general supervision, oversight of data, and clinical decision making; the professional evaluation codes (96130–96133) capture those services.

Denial Risk

NCCI edit risk when billing 96136 and 96138 same day

Billing both 96136 (provider administered) and 96138 (technician administered) for the same patient on the same day can trigger NCCI edits and denials unless appropriate modifiers and documentation justify separate services.

Do not bill 96136 and 96138 for the same patient on the same date of service without an appropriate modifier and clear documentation of distinct services and medical necessity.
If both a psychologist/QHP and a technician contribute to administration/scoring, document the separate activities, time units, and supervisory oversight to support billing.
Expect NCCI edit review when submitting both codes; include documentation in the record to support the claim if concurrently billed.

Psychological/neuropsychological testing codes — service mapping

96130Psychological testing evaluation services by physician or other qualified health care professional; first hour (integration of patient data, interpretation of standardized test results, clinical decision making, treatment planning, report, interactive feedback).

96131Psychological testing evaluation services; each additional hour (add-on to primary procedure).

96132Neuropsychological testing evaluation services by physician or other qualified health care professional; first hour (integration and interpretation, clinical decision making, treatment planning, report, interactive feedback).

96133Neuropsychological testing evaluation services; each additional hour (add-on to primary procedure).

96136/9613796136: Test administration and scoring by physician/QHP, two or more tests; first 30 minutes. 96137: Each additional 30 minutes (add-on).

96138/9613996138: Test administration and scoring by technician, two or more tests; first 30 minutes. 96139: Each additional 30 minutes (add-on).

96127 (screening guidance)Brief emotional/behavioral assessment (e.g., ADHD scale) with scoring and documentation; use CPT 96127 for ADD/ADHD screening rather than full testing codes.