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See a sample rate comparisonCPT 96131 Fee Schedule
Last Verified: October 2026
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.
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
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Central Nervous System Assessments/Tests (eg, Neuro-Cognitive, Mental Status, Speech Testing) |
| Common Place of Service | 11 - Office 10 - Telehealth in Patient's Home |
| Common Modifiers | 95 - Telemedicine - audio and video AH |
| Complexity Level | Low |
| Medicare Fee Schedule | $86.51 national non-facility rate (2026) · View Medicare rates for 96131 |
| Medicaid Fee Schedule | $76.945 median of the 8 states in the free preview · View Medicaid rates for 96131 |
National average reimbursement for CPT 96131 by major payers:
$106.64
$108.86
$101.34
$138.96
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CPT 96131
5 of 25 sample ratesHigher to lower in this preview
Rachel Becker-Warner
Group Health Plan Inc
$252.63Published rateLaura Long
$114.80Published rateJamie Evans
Blessing Hospital
$99.40Published ratePaul Knabb
$86.75Published rateSusan Hyman
Danari Inc
$79.44Published rate
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See a sample payer proposalCPT 96131 vs. Other Central Nervous System Assessments/Tests (eg, Neuro-Cognitive, Mental Status, Speech Testing) Codes
The CPT 96131 code is part of the Medicine Services and Procedures services used for Central Nervous System Assessments/Tests (eg, Neuro-Cognitive, Mental Status, Speech 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 96131 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 96131. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96131 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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