CurrentOptumPolicy N/A

Psychological and Neuropsychological Testing Reimbursement

Governs billing and reimbursement rules for psychological and neuropsychological testing services (CPT codes 96116, 96130-96139, 96146, etc.) for services billed on CMS-1500 and equivalent electronic claims for Optum-administered behavioral health benefits.

Policy Summary

PayerOptum

PolicyPsychological and Neuropsychological Testing Reimbursement

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionSubmit accurate claims on CMS-1500 or electronic equivalents; Optum may apply claim edits via iCES Clearinghouse.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

96116/96130-96139/96146Primary codes discussed

1 per episodeBase code rule

Use add-on codesAdd-on units

Standalone only96146 restriction

Reimbursement and Coverage Criteria

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 of the following

Evaluation codes: use either the psychological (96130/96131) OR the neuropsychological (96132/96133) evaluation code set that best represents the predominant service; do not bill both sets in one episode.
Test administration and scoring codes: include appropriate administration/scoring codes (96136/96137 and/or 96138/96139) in the episode.
Cumulative reporting: when services occur over multiple visits, cumulative time for each service type should be reported at episode completion and the single bill should list both base and add-on codes with dates linked to the entire episode.

ALL of the following

Base codes include 96130, 96132, 96136, and 96138 (one unit only per episode).
Add-on codes to report subsequent units are 96131, 96133, 96137, and 96139.

Code 96146 (automated testing result) may be billed only as a standalone service when a single automated standardized instrument is used and no other measures are administered; do not use 96146 if additional tests are administered.

ALL of the following

Submit accurate claims on the CMS-1500 (or electronic equivalent).
Optum follows APA and CMS/NCCI guidance and may apply claim edits (for example via iCES Clearinghouse) and discretion in applying this policy when processing claims.

ALL of the following

If standardized tests administered could be used for either psychological or neuropsychological evaluations, choose the single set of evaluation codes that best represents the predominant service for that episode (do not bill both 96130/96131 and 96132/96133).

ALL of the following

An episode begins with administration and scoring and concludes when the evaluation report is complete, including interactive feedback when performed; the episode should be billed as a single episode with base and add-on codes linked to the episode dates.

ALL of the following

Do not bill multiple units of base codes within an episode; use add-on codes for subsequent units even if services occur on different days.
Do not bill 96146 when additional tests are administered; 96146 is limited to a single automated instrument with automated result only.

ALL of the following

Providers are responsible for accurate claim submission; Optum’s reimbursement policy applies to services reported on the CMS-1500 or electronic equivalent and may be subject to claim edits and review.

Psychological and Neuropsychological Testing Codes

Psychological and Neuropsychological Testing CodesCPTCovered

96116	Neurobehavioral status exam; first hour (can be billed alone or with 96132-96133 and 96136-96139).
96121	Add-on code: each additional hour for 96116.
96130	Psychological testing/evaluation services, first hour (base).
96131	Add-on: each additional hour for 96130.
96132	Neuropsychological testing/evaluation, first hour (base).
96133	Add-on: each additional hour for 96132.
96136	Test administration and scoring by physician/qualified professional, two+ tests, first 30 minutes (base).
96137	Add-on: each additional 30 minutes for 96136.
96138	Test administration and scoring by technician, two+ tests, first 30 minutes (base).
96139	Add-on: each additional 30 minutes for 96138.

1–10 of 11

1/2

Base code unit limit per episode

Base code unit limit per testing episodeOne unit of each base code (96130, 96132, 96136, 96138) may be billed only one time during a testing episode; subsequent units must be billed using add-on codes (96131, 96133, 96137, 96139).

Applies across multiple daysWhen services occur over multiple visits, report cumulative time and list base and add-on codes linked to the entire episode; still only one base unit is allowed.

Base codes definedExamples of base codes: 96130 (psychological testing first hour), 96132 (neuropsychological testing first hour), 96136 (test administration/scoring by qualified professional, first 30 minutes), 96138 (test administration/scoring by technician, first 30 minutes).

Claims Submission and Provider Responsibilities

Billing Rule

Submit accurate CMS-1500 or electronic claims; Optum may apply discretion and claim edits

Submit accurate claims on the CMS-1500 (1500 Health Insurance Claim Form) or its electronic equivalent; Optum may apply discretion in interpreting/applying this policy and uses claim edits that can affect processing (iCES Clearinghouse).

This policy applies to services reported using the CMS-1500 or electronic equivalents (including 837P/837I and provider portal submissions).
You are responsible for submission of accurate claims describing the services provided; Optum may use reasonable discretion in applying the policy and electronic claim processing systems (e.g., iCES Clearinghouse) may implement edits that affect payment.

Definitions Used in This Policy

Episode of Testing — definition

Episode start and endAn episode begins with test administration and scoring and concludes when the evaluation report is complete. Interactive feedback with the patient/family is expected as a typical component of the evaluation process.

Cumulative reportingWhen services occur over multiple visits, cumulative time for each service type (evaluation and test administration/scoring) should be reported at episode completion and linked to the single episode.

Single bill requirementA single bill should list both base and add-on codes with the different dates of service linked to the entire episode of evaluation.

Automated Testing Result (CPT 96146)

Definition of 96146CPT 96146: Automated testing with a single automated, standardized electronic instrument that produces automated results; billed only as a standalone service when no other measures are administered.

Standalone-only restrictionDo not bill 96146 when additional tests or other evaluation measures are administered during the episode; in those cases use the 96136-96139 series for test administration and scoring.

Appropriate use caseUse 96146 only when a single computerized testing measure is used and no other measures will be administered.