CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Psychological and Neuropsychological Testing Services Coverage and Coding Guidelines

Defines Neighborhood Health Plan of Rhode Island coverage, coding, documentation, and claims guidelines for psychological and neuropsychological testing services for Medicaid (excluding EFP), INTEGRITY, and Commercial members.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyPsychological and Neuropsychological Testing Services Coverage and Coding Guidelines

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateSep 1, 2025

Next Review DateN/A

Key ActionVerify member eligibility, coverage, and authorization requirements prior to rendering services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

multiplelisted billable procedure codes

3scope (plan types)

1-800-963-1001contact for questions

Coverage criteria and medical necessity

Coverage criteria and billing conditions

Covered when ALL of the following conditions are met:

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

All services are medically necessary to qualify for reimbursement; Neighborhood may use Local Coverage Determinations (LCD), National Coverage Determinations (NCD), industry-accepted criteria such as InterQual, Rhode Island Executive Office of Health and Human Services (EOHHS) recommendations, and Clinical Medical Policies to determine medical necessity.

The provider verifies eligibility, coverage, and authorization criteria prior to rendering services; refer to the plan-specific Prior Authorization Reference page and Neighborhood Clinical Medical Policies as needed, and contact Provider Services at 1-800-963-1001 for questions.

Documentation to support billed services and medical necessity must be maintained in the medical record; Neighborhood reserves the right to request medical records for any service billed per policy and CMS standards.

Claims must be submitted complete and within contractual timely filing limits, using standard AMA CPT and HCPCS coding as applicable.

Psychological and Neuropsychological testing CPT/HCPCS

Psychological and Neuropsychological testing CPT/HCPCSCPTCovered

96116	Neurobehavioral status exam, first hour
96121	Neurobehavioral status exam, each additional hour
96130	Psychological testing evaluation services, first hour
96131	Psychological testing evaluation services, each additional hour
96132	Neuropsychological testing evaluation services, first hour
96133	Neuropsychological testing evaluation services, each additional hour
96136	Test administration and scoring by qualified professional, first 30 minutes
96137	Test administration and scoring by qualified professional, each additional 30 minutes
96138	Test administration and scoring by technician, first 30 minutes
96139	Test administration and scoring by technician, each additional 30 minutes

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Provider actions, authorization, documentation, and claims

Prior Authorization

Prior authorization and eligibility verification

Verify member eligibility, coverage, and any required prior authorization before rendering services. Refer to the plan-specific Prior Authorization Reference page and Clinical Medical Policies for authorization criteria; contact Provider Services at 1-800-963-1001 with questions.

Providers are responsible to verify eligibility, coverage and authorization criteria prior to rendering services.
See Neighborhood's plan-specific Prior Authorization Reference page and Clinical Medical Policies for details.

Documentation Required

Neighborhood may request medical records to support billed services

Neighborhood may request medical records for any billed service; documentation must support the billed service(s) and the medical necessity per CMS standards.

Neighborhood reserves the right to request medical records for any service billed.
Documentation must support the services billed and medical necessity and follow CMS documentation standards.

Billing Rule

Claim submission and coding rules

Submit complete claims for payment within contractually determined timely filing limits and use AMA CPT and HCPCS Level II coding standards.

Billable services are subject to contractual agreements and timely filing guidelines.
Coding must meet AMA CPT and HCPCS Level II standards.

Code definitions and brief descriptions

inv-06: 96116 / 96121 — Neurobehavioral status exam (compact definition)

Codes96116 (first hour) and 96121 (each additional hour)

Service descriptionNeurobehavioral status exam: clinical assessment of thinking, reasoning and judgment (e.g., acquired knowledge, attention, language, memory, planning and problem solving, visual abilities).

ProviderPerformed by a physician or other qualified health care professional, includes face-to-face time, interpretation of test results, and report preparation.

Billing note96121 is billed separately in addition to the primary procedure for each additional hour.

inv-07: 96130 / 96131 — Psychological testing evaluation services including integration of data and interpretation

Codes96130 (first hour) and 96131 (each additional hour)

Service descriptionPsychological testing evaluation services including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning, report, and interactive feedback to the patient (and family/caregiver when performed).

ProviderPerformed by a physician or other qualified health care professional; includes comprehensive evaluation and reporting.

Billing note96131 is listed separately in addition to the primary procedure for each additional hour.

inv-08: 96132 / 96133 — Neuropsychological testing evaluation services including integration of data and interpretation

Codes96132 (first hour) and 96133 (each additional hour)

Service descriptionNeuropsychological testing evaluation services including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning, report, and interactive feedback to the patient (and family/caregiver when performed).

ProviderPerformed by a physician or other qualified health care professional; includes comprehensive neuropsychological evaluation and reporting.

Billing note96133 is listed separately in addition to the primary procedure for each additional hour.