96136 CPT Code

If you’re looking for information on the 96136 CPT code, this article includes the 96136 CPT code description, modifiers, time limits, and other helpful behavioral health codes.

Searching for the correct CPT codes is necessary to support a diagnosis and treatment plan and to accurately bill insurance and receive reimbursements.  

Understanding the healthcare coding system and knowing when to use the 96136 CPT code can free up time otherwise spent on administrative tasks, giving you more time to spend doing what you enjoy.

This guide to psychological testing codes provides the 96136 CPT code description, time limit information, modifiers, and reimbursement information for the 96136 CPT code.

What are CPT codes?

The American Medical Association (AMA) created Current Procedural Terminology (CPT) codes to define diagnostic services, healthcare procedures, and types of surgery. 

Providers, including mental health clinicians, use CPT codes to ensure standardized language is used globally. This improves accuracy of clinical documentation, streamlines reporting, and allows for data tracking to identify health trends. 

CPT codes are also a crucial part of insurance billing required for reimbursement for services. Even if a clinician doesn’t bill insurance, a CPT code can be used to provide clients with superbills to submit a claim on their own, for reimbursement from their insurance payer. 

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What is the 96136 CPT code description?

You’ll find the 96136 CPT code among testing and examination codes. 

The 96136 CPT code is used for psychological or neuropsychological testing and scoring. 

The 96136 CPT code description specifies that the provider must administer two or more psychological or neuropsychological tests and score them. The tests may be electronic, paper, or verbal. 

Examples of tests administered under this code include:

• Question and answer based interviews
• Performance-based tests, like responses to pictures or patterns
• Self-reported questionnaires
• Written tests
• Computer-based tests, which may be multiple choice and measure intellectual ability, decision-making, strategy formation, executive function, personality characteristics, stress, coping, and problem-solving abilities 

The American Psychological Association guidelines state the person who administers, selects, and interprets the test for the 96136 CPT code must be a physician or other qualified health care professional, such as a psychologist or neuropsychologist. 

This is consistent with some insurance guidelines. As Optum states, a “physician or other qualified mental health professional” may use this code. 

96136 CPT code time

The 96136 CPT code is used for the first 30 minutes of the test administration and scoring. However, as with most CPT codes, there is a minimum time limit of 16 minutes.

If a clinician takes more than 30 minutes administering a test and scoring, the provider will also use the CPT code 96137 for each additional 30 minutes. 

For example: 

• 16 to 30 minutes of test administration and scoring: Use the 96136 CPT code.
• An additional 30 minutes of test administration and scoring: Use 96136 + 96137.

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96136 CPT code modifiers

Healthcare professionals may bill the 96136 CPT code with evaluation and management code modifier 25. However, it must be a separately identifiable evaluation and management. Modifier 59 is used if a technician takes over the testing from the clinician.  

If the client leaves the office and returns for an additional test on the same day, modifier XE can be used. XE indicates testing during separate encounters.

96136 CPT code reimbursement rates

The 96136 CPT code is reimbursed by private insurance and Medicare. 

Each insurance company varies in reimbursement rates, whereas Medicare has set reimbursement rates.

• Medicare: In 2024, the 96136 CPT code reimbursement rate was about $41.61. In 2022 it was $49.15, and reduced to $42.70 in 2023.
• Average reimbursement: According to Screen Inc, a national testing provider, the average reimbursement for CT codes 96136 and 96137 is $85.48.

Other testing and evaluation codes

The main CPT codes used for psychological testing include:

96110

• Psychological Testing Involves: Developmental screening and testing
• Developmental testing per standardized instrument
• Explanation: Used to evaluate developmental milestones like speech and language in children

96112

• Psychological Testing Involves: Developmental test administrator of language, fine/gross motor skills, cognition, social, memory, and executive functions
• Explanation: Includes screening and subjective data from the child’s observer. Typically 60 minutes duration. However, the modifier 96113 may be used for every additional 30 minutes.

96105

• Psychological Testing Involves: Assessment of aphasia and cognitive performance
• Explanation: Includes administration of test, scoring, and interpretation.

96125

• Psychological Testing Involves: Cognitive performance testing
• Explanation: Used by speech and language pathologists.

96116

• Psychological Testing Involves: Neurobehavioral status exam
• Explanation: A face-to-face assessment of the patient's thinking, reasoning, and judgment. This code includes the testing, interpretation, and preparation of a report.

96130

• Psychological Testing Involves: Psychological testing, interpretation, clinician decision making, treatment planning, and interactive feedback
• Explanation: 60 minutes. May add 96131 CPT code for every additional 30–60 minutes.

96132

• Psychological Testing Involves: Psychological testing, interpretation, treatment planning, and discussing the outcome with the client and their family members
• Explanation: 60 minutes testing, interpretation, and report writing, before patient and caregiver discussion. However, code 96133 can be used for each additional hour.

96136

• Psychological Testing Involves: Psychological or neuropsychological test administration and scoring
• Explanation: First 30 minutes of test administration by a qualified (doctoral-level) mental health professional.

96137

• Psychological Testing Involves: Psychological or neuropsychological tests
• Explanation: The use of the 96137 CPT code denotes administering two or more tests and scores, and requires an additional 30 minutes beyond the first 30 minute assessment.

96138

• Psychological Testing Involves: Neuropsychological tests administration scoring by a technician
• Explanation: For the first hour. Additional hours may be billed with code 96139 for each additional hour.

Sources

• American Psychological Association. Neuropsychological Testing. 
• Covered by Medicare and Most Private Insurance. https://screen-inc.com/physician-fees/ 

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