CPT 96130 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Psychological and Neuropsychological Testing Evaluation Services Psychological and Neuropsychological Testing |
| Common Place of Service | 11 - Office None 10 - Telehealth in Patient's Home |
| Common Modifiers | None 59 - Distinct Procedural Service 95 - Telemedicine - audio and video |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 96130 |
National average reimbursement for CPT 96130 by major payers:
$144.52
$144.76
$133.64
$174.09
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 96130 | $219.28 | 1912385295 - ALYSSA STRAM | 911780160 | IL | Psychiatry Physician (2084P0800X) |
United | 96130 | $111.08 | 1861483703 - JOHN HAMILL | 812810137 - (OH) OHIO PSYCHIATRIC SERVICES LLC | OH | Psychiatry Physician (2084P0800X) |
United | 96130 | $170.35 | 1124047295 - TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER EL PASO, TEXAS TECH UNIVESITY HEALTH SCIENCES CENTER NEUROPSYCHIATRY | 752668016 | TX | Psychiatry Physician (2084P0800X) |
United | 96130 | $120.30 | 1619138724 - JOSEPH RIEMAN | 310536969 - (OH) CHILDRENS HOME OF CINCINNATI OHIO INC | OH | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 96130 | $332.01 | 1679968697 - JEREMIAH BREWER | 205996177 | WI | Psychiatry Physician (2084P0800X) |
United | 96130 | $120.30 | 1528563574 - GRACE KANG | 742795332 - (TX) BLUEBONNET TRAILS COMMUNITY MHMR CENTER | TX | Psychiatry Physician (2084P0800X) |
United | 96130 | $114.29 | 1619088457 - ELIZABETH ANTON | 1619088457 - (NC) ELIZABETH ANTON | NC | Clinical Psychologist (103TC0700X) |
United | 96130 | $129.05 | 1760015341 - MARIAM HENDERSON-RUCKER | 861747274 | OH | Clinical Social Worker (1041C0700X) |
United | 96130 | $130.67 | 1497949135 - HOLLIE ANDREWS | 834508286 - (NY) WELLROUND PROVIDER GROUP PA | MI | Social Worker (104100000X) |
United | 96130 | $120.30 | 1568581056 - MICHAEL DEBERARD | 920986068 | UT | Clinical Psychologist (103TC0700X) |
United | 96130 | $111.08 | 1033691217 - AUTUM SYFERT | 202605791 - HOPEBRIDGE, LLC | FL | Behavioral Analyst (103K00000X) |
United | 96130 | $225.05 | 1942400924 - KATHERINE JOHNSON | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 96130 | $160.10 | 1023401452 - CRYSTAL SHORES | 464814778 - (MN) CARE CLINICS, LLC | MN | Psychologist (103T00000X) |
United | 96130 | $120.30 | 1841659448 - TIMOTHY WALKER | 475416774 - (MI) MCDOWELL HEALING ARTS CENTER LLC | MI | Clinical Social Worker (1041C0700X) |
United | 96130 | $216.33 | 1487694279 - KENNETH FILS | 364011995 - (IL) DAVKEN ASSOCIATES PC | IL | Clinical Psychologist (103TC0700X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 96130 vs. Other Psychological and Neuropsychological Testing Codes
The CPT 96130 code is part of the Psychological and Neuropsychological Testing Evaluation Services services used for Psychological and Neuropsychological Testing. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 96130 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 96125-CPT | Low | Cognitive Test By Hc Pro, Standardized Cognitive Performance Testing Eg Ross Information Processing Assessment Per Hour Of A Qualified Health Care Professional S Time Both Face To Face Time Administering Tests To The Patient And Time Interpreting These Test Results And Preparing The Report |
| 96127-CPT | Low | Brief Emotional Behav Assmt, Brief Emotional Behavioral Assessment Eg Depression Inventory Attention Deficit Hyperactivity Disorder Adhd Scale With Scoring And Documentation Per Standardized Instrument |
| 96130-CPT | Low | Psycl Tst Eval Phys Qhp 1st, Psychological Testing Evaluation Services By Physician Or Other Qualified Health Care Professional Including Integration Of Patient Data Interpretation Of Standardized Test Results And Clinical Data Clinical Decision Making Treatment Planning And Report And Interactive Feedback To The Patient Family Member S Or Caregiver S When Performed First Hour |
| 96131-CPT | Low | Psycl Tst Eval Phys Qhp Ea, Psychological Testing Evaluation Services By Physician Or Other Qualified Health Care Professional Including Integration Of Patient Data Interpretation Of Standardized Test Results And Clinical Data Clinical Decision Making Treatment Planning And Report And Interactive Feedback To The Patient Family Member S Or Caregiver S When Performed Each Additional Hour List Separately In Addition To Code For Primary Procedure |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96130. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96130 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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