CPT code 96116 is used for the first hour of a neurobehavioral status exam done by a psychologist or neuropsychologist to check thinking, reasoning, and judgment through clinical interviews and standardized tests.
Who can bill CPT code 96116?
Only licensed psychologists or neuropsychologists can bill CPT code 96116 for that first hour of testing.
This covers the time you spend face-to-face with the patient, interpreting results, and writing up the report. The American Psychological Association (APA) says these services need professionals with special training in psychological and neuropsychological assessment. Billers should remember that Medicare only pays for this when a qualified provider does the work.
What CPT code replaced 96116?
CPT code 96116 hasn’t been replaced—it’s still the right code for the first hour of a neurobehavioral status exam.
But any time beyond that first hour now goes under add-on code 96121. The American Medical Association (AMA) changed the billing setup to make it clearer and let you report service length more precisely.
Does Medicare pay for 96116?
Yes, Medicare covers CPT code 96116 when a qualified psychologist or neuropsychologist bills it.
How much you get back varies by region and whether the service happens in an office or a facility. As of 2026, the national average reimbursement for 96116 runs about $120–$180, according to the Medicare Physician Fee Schedule. Always double-check local coverage rules and use the right modifiers when you need them.
Does 96116 need a modifier?
Yes, some settings require a modifier on CPT code 96116—especially in Federally Qualified Health Centers.
The CMS MLN Matters guidance says FQHCs must add modifier -93 for services given by telehealth at the same time. Other modifiers like -59 can show up in specific cases to mark separate procedural services.
Who can bill CPT code 96127?
Primary care doctors, psychiatrists, and other qualified clinicians can bill CPT code 96127 when it’s properly supervised.
This code covers quick emotional or behavioral checks—think PHQ-9 or GAD-7 screenings—in a primary care office. A physician has to oversee the service, and it must be medically necessary with solid documentation. The American Academy of Pediatrics backs using these screenings in pediatric care as part of integrated behavioral health programs.
What does CPT code 96131 mean?
CPT code 96131 is an add-on for every extra hour of psychological testing done by a psychologist.
You bill it with the first-hour code 96130 and it covers giving tests, scoring them, interpreting results, and pulling together the clinical picture. The APA points out this code supports thorough evaluations that go way beyond a quick screen.
Who can bill for 96132?
Doctors and other qualified pros with neuropsychology or neurology expertise can bill CPT code 96132.
This code covers full neuropsychological testing—interpreting standardized tests, making clinical decisions, and planning treatment. The Northeastern University Psychology Department says these evaluations are usually done by licensed clinical neuropsychologists or neurologists with special training in cognitive assessment.
What does CPT code 96150 mean?
CPT code 96150 covers a 15-minute face-to-face health and behavior check focused on how psychosocial issues affect physical health.
It includes clinical interviews, behavioral observations, and health-focused questionnaires. You’ll often see this in integrated care for things like chronic pain, diabetes distress, or cardiac rehab. The APA Division 38 has guidance on using this code in behavioral medicine.
What does CPT code 90791 mean?
CPT code 90791 is a 60-minute combined biopsychosocial evaluation that includes history, mental status, and treatment recommendations.
Introduced in 2013 as part of the Mental Health CPT updates, 90791 replaced older codes like 90801. Psychiatrists, psychologists, and clinical social workers use it to kick off treatment planning. The American Psychiatric Association (APA) calls this a true holistic assessment covering biological, psychological, and social factors.
How Much Does Medicare pay for 90834?
As of 2026, Medicare pays around $115–$135 for CPT code 90834 (a 45–50 minute psychotherapy session).
Exact rates depend on your location and the practice expense index. Always check the Medicare Physician Fee Schedule each year for updates. You’ll often bill this alongside evaluation and management services when it makes sense.
Who can bill for 96101?
Licensed psychologists and doctors can bill CPT code 96101 for psychological testing.
That said, the 2021 CPT updates mostly swapped this code out for 96130 and 96131 for psychological testing evaluations. The AMA made the change to be more specific and cut down on redundancy.
Who can perform a neuropsychological evaluation?
A licensed clinical neuropsychologist, psychologist, or supervised psychometrist can do a neuropsychological evaluation.
Psychometrists are trained techs who give and score tests under a licensed psychologist’s supervision. These evaluations usually run 3 to 6 hours, depending on how many tests are needed and how complex they are, according to the ScienceDirect review of neuropsychological practices.
Can you bill 99213 and G0439 together?
No, billing CPT 99213 and HCPCS G0439 (AWV) together is generally a bad idea under Medicare because they overlap so much.
Medicare’s MLN Matters guidance warns these services often include the same preventive elements. While you can bill 99213 with G0438/G0439 if it’s medically necessary, your notes have to clearly show why both services were needed.
Does 96132 need a modifier?
Yes, CPT code 96132 may need modifier -59 or -XU when you bill it with certain other services to show separate procedures.
Since April 2019, CMS has required the -59 modifier for codes like 96132 when they’re done the same day as overlapping cognitive testing. That keeps claims from getting bundled incorrectly and helps make sure you get paid right.
Who can perform 96156?
Only licensed clinical psychologists can perform services billed under CPT code 96156.
Back in January 2020, codes 96150–96154 got rolled into 96156 for health and behavior intervention services. These services tackle the psychosocial side of physical health problems and need special training in behavioral medicine. The APA has detailed rules on who qualifies and how to use the code.
