96130: Psychological testing evaluation services, first hour
96130 is the psychologist's evaluation time: integrating test results, history, and observations, forming the diagnosis, planning treatment, and the feedback session with the family. It is the intellectual work of the evaluation, billed per hour, first hour with 96130 and each additional hour with 96131.
- Kind
- CPT code
- Family
- testing
- Time
- First 60 minutes; 96131 for each additional hour
- Who bills
- Psychologists
- Telehealth
- Eligible
- Add-on
- Stands alone
When to use it
Use it for the hours spent interpreting and integrating data and for interactive feedback with the parent and child. It is billed on the date the work is done, which may be after the testing dates.
When not to
Do not use it for administering or scoring tests (that is 96136 to 96139), or for report writing that is not part of the evaluation service under your payer's definition. Do not bill 96130 twice on one date; use 96131 for additional hours.
With children and families
A comprehensive ADHD or autism evaluation for a child brings together rating scales from parents and teachers, MIGDAS-2 or ADOS-style observation, RIAS-2 or similar cognitive data, developmental history, and school reports. Document each source, how the pieces fit, the diagnostic conclusion, and the recommendations schools and pediatricians can act on. The feedback session with the parent counts here.
Questions about 96130
- Can 96130 and 96136 be billed on the same day?
- Yes, when both services happen and the times are separate and documented.
- How many hours does a typical child ADHD evaluation take?
- Commonly two to four evaluation hours plus two to four testing hours, depending on the referral question. Document the actual time.
- Do I need PSYPACT to evaluate across state lines?
- Yes, unless you hold that state's license. Emora psychologists evaluate across every PSYPACT state.
Related
| Code | What it is | Time | Who bills | Telehealth |
|---|---|---|---|---|
| 96116 | Neurobehavioral status exam, first hour | First 60 minutes; 96121 for each additional hour | Psychologists | Yes |
| 96131 | Psychological testing evaluation services, each additional hour | Each additional 60 minutes after 96130 | Psychologists | Yes |
| 96136 | Test administration and scoring by psychologist, first 30 minutes | First 30 minutes; 96137 for each additional 30 minutes | Psychologists | Yes |
| 96137 | Test administration and scoring by psychologist, each additional 30 minutes | Each additional 30 minutes after 96136 | Psychologists | Yes |
General information for licensed clinicians, not billing advice. Insurers reimburse each code differently and payer contracts control; Emora handles the billing.
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