CPT 96136 - New psychological testing code

Shondell 5 years ago in Codes/Rates/Diagnosis Modules updated by Jenna 5 years ago 17

Has anyone had anyone found documentation regarding the billing of this code?  We are questioning the two or more tests requirement before this can be billed.  All I have found is that it means in a session.  Is a session each day or is the session the whole testing time from start to finish?  How is everyone else handling this?

After speaking with our Psychologist who is billing for these services it is our understanding that you would bill the 96136 for administering the tests and for the time spent scoring tests.  You need to be administering and scoring at least two tests.  Our Psychologist states that more than one test is always utilized when conducting psychological testing so this meets that requirement. You would bill for the whole testing time start to finish.  i.e.  3 hours to administer and/or score tests= 1 unit of the 96136 & 5 units of the 96137.  You can find the Psychological Testing codes and descriptions for 1/1/2019 on the American Psychological Association's website by searching Psychological testing codes effective January 1 2019.  Hope this helps.

I have a related question. I am wondering about situations in which the psychologist only needs to administer one test, such as the MMPI.  Am wondering how others are handling this fairly common situation. 


The CPT code states two or more tests so our assumption is that you can only bill the 96130(Psychological testing evaluation services first hour + 96131(each additional hour) for the testing evaluation services and are unable to bill for the administration and scoring when it is only one test. 

Thanks to Kelli for a prompt response.  Her response fit with my reading of the new CPT guidelines.  This raises an interesting question of how to chose what test, or tests, to use, based on medical necessity.  I wonder if an insurance company would give you a hard time if you did only one test, and defended this choice by stating that only one test was medically necessary and you could not, based on medical necessity,add a second test. This is assuming that the rest of your billing was congruent with use of only one test. 

Good point Richard, we all should probably check with the members insurance prior to providing the service to see what their requirements are as sometimes they do deviate from the CPT guidelines. I did look to see if UBH had anything posted on the new psych codes yet and their documentation is for the old codes. Once I receive notification from UBH on this I will try and remember to post my findings.  Just an FYI we have been finding that most insurance carriers are behind with the updates to the new Psych codes.

Thanks again to Kelli, 

There as been some discussion on MPA listservs, with quite a bit of frustration, about how insurance companies have not entered the new codes into their payment system and have not updated their testing policies. Of course, if we providers were late on something important like this, the insurance companies would chastise us and penalize somehow.  We can only wait .....

Thank you for all the responses.  I am glad to hear I am not the only one with frustration.  :)

As promised attached please find UBH's Testing Guidelines for Psychological and Neuropsychological Testing which was updated to reflect new coding. UBH psych testing guidelines

Hoping someone is able to help me out.  We have been billing psych testing codes 96136 (1) and 96137 (additional testing units) and not getting paid for any.  I spoke with one rep who said all codes need to be billed on the same invoice.  Has anyone else ran into this?  Our psychologist does testing on one day and then the report often is completed days to weeks later, depending on if more testing is needed (or if the patient is a young child who can't sit through hours of testing.)

Is billing all psych codes together a requirement?  I was under the impression the 96136 was primary/96137 was an add on; and that 96130 is primary; and 96131 is an add-on.  I have been told that 96130 & 96131 are primary and 96136 & 96137 are add-ons. Is this true?  Do you wait until the entire psych report is written before billing anything? 

I do billing for this quite a bit.  Everything should be billed out with the same date on one claim.  We wait until the entire report is done before submitting a claim.  You will find that NCII edits will cause claims to deny if you do not use the modifier.  If you bill out a 96138 or 96139 with any of the other codes, these 2 need a modifier.  I have been using modifier 59.  The problem I am running into is if the provider does a feed back session after the testing has been billed.  I know we can get paid for it, but I haven't been able to get claims through.

Thank you for your response.  So, to be clear, no matter when the testing was actually administered, you bill all codes on the day the report is completed and signed?  Do you document that the testing was done on different days? or does that not matter?


Yes bill everything on the day the report was written.  The dates of testing should be included in the report itself.


I haven't had much trouble but mine have been going out on one claim

So that may be the issue for me then---Can I ask you a couple more questions?  How often do you bill? and what is the turnaround from testing to the actual report being completed?  Do you purposely wait to bill all psych codes together?

I only have one clinician who does Psych testing and he doesn't do it very often.  He does all the coding so I am not sure if he does it all in one day or not.  


I have a few questions ---  Are 96130/93131 only to be billed after a test has been given? And these codes do not include testing AND evaluation but rather evaluation OF a test that was given? 

Testing codes being 

96136/96137 96138/96139 or 96146 depending on who is giving them. 

Is an LADC LPPC a qualified professional to deliver 96136/96137 without supervision attached?