CPT Code 96130: Psychological testing evaluation, first hour

When to Use CPT 96130

Use CPT code 96130 when billing for psychological testing evaluation, first hour. This code is used by licensed therapists (LCSW, LPC, MFT, Psychologist) for outpatient sessions.

Adding CPT 96130 to a Superbill

When generating a superbill with CPT 96130, include the ICD-10 diagnosis code, date of service, fee charged, amount paid, and your NPI number. Superbilled pre-fills common therapy CPT codes automatically.

Common ICD-10 Pairings

These diagnosis codes are frequently used alongside CPT 96130:

Documentation Requirements

Document the clinical rationale for testing, specific tests administered, interpretation time, and how results inform diagnosis and treatment planning.

Common Denial Reasons

• ✗ Missing clinical rationale or referral question for testing
• ✗ Testing not deemed medically necessary by the payer
• ✗ Billed with administration codes (96136-96139) without proper distinction

Reimbursement Expectations

OON reimbursement typically 50-70% of UCR. Expect $100-$280 for the first hour of evaluation.