How To Use CPT Code 96131

CPT 96131 refers to psychological testing evaluation services provided by a physician or other qualified healthcare professional, including data integration, test result interpretation, clinical decision making, treatment planning, and interactive feedback. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 96131.

1. What is CPT 96131?

CPT 96131 is a medical billing code used to describe psychological testing evaluation services provided by a physician or other qualified healthcare professional. These services include the integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning, and interactive feedback to the patient, family member(s), or caregiver(s), when performed. This code is billed for each additional hour of psychological testing, in addition to the primary code (96130) for the first hour of service.

2. 96131 CPT code description

The official description of CPT code 96131 is: “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)”.

3. Procedure

The procedure for CPT 96131 involves the following steps:

1. Administering standardized psychological tests to the patient.
2. Interpreting the results of the tests and integrating them with other clinical data.
3. Making clinical decisions based on the test results and other data.
4. Developing a treatment plan for the patient.
5. Preparing a report on the testing, interpretation, and treatment plan.
6. Providing interactive feedback to the patient, family member(s), or caregiver(s) regarding the test results, diagnosis, and treatment plan.

This code is billed for each additional hour of psychological testing, beyond the first hour, which is billed using the primary code (96130).

4. Qualifying circumstances

Eligible recipients of CPT code 96131 services include patients who require psychological testing for various reasons, such as:

• Diagnosing mental health disorders.
• Evaluating cognitive functioning.
• Assessing personality traits and characteristics.
• Identifying learning disabilities or developmental delays.
• Monitoring progress in therapy or treatment.

The provider must be a physician or other qualified healthcare professional, such as a psychologist or licensed clinical social worker, who is trained and experienced in administering and interpreting psychological tests.

5. When to use CPT code 96131

It is appropriate to bill the 96131 CPT code when a physician or other qualified healthcare professional provides psychological testing evaluation services for each additional hour beyond the first hour of service. The first hour of service is billed using the primary code (96130). CPT 96131 should be used when the provider spends additional time administering tests, interpreting results, making clinical decisions, developing treatment plans, preparing reports, and providing interactive feedback to the patient, family member(s), or caregiver(s).

6. Documentation requirements

To support a claim for CPT 96131, the following information should be documented:

• The specific psychological tests administered and their purpose.
• The time spent administering the tests, interpreting the results, and providing feedback (in hours).
• A detailed report of the test results, interpretation, clinical decision making, and treatment plan.
• Any interactive feedback provided to the patient, family member(s), or caregiver(s).
• The credentials of the provider administering the tests and providing the services.

7. Billing guidelines

When billing for CPT code 96131, keep in mind the following guidelines and rules:

• Bill CPT 96131 for each additional hour of psychological testing evaluation services, beyond the first hour, which is billed using the primary code (96130).
• Ensure that the provider administering the tests and providing the services is a physician or other qualified healthcare professional.
• Maintain thorough documentation of the testing, interpretation, clinical decision making, treatment planning, and interactive feedback provided.
• Be aware of any payer-specific requirements or guidelines for billing psychological testing evaluation services.

8. Historical information

CPT 96131 was added to the Current Procedural Terminology system on January 1, 2019. There have been no updates to the code since its addition.

9. Similar codes to CPT 96131

Five similar codes to CPT 96131 include:

• CPT 96130: This code is used for the first hour of psychological testing evaluation services, while CPT 96131 is used for each additional hour.
• CPT 96132: This code covers neuropsychological testing evaluation services by a physician or other qualified healthcare professional, focusing on cognitive functioning and neurological disorders.
• CPT 96133: This code is used for each additional hour of neuropsychological testing evaluation services, beyond the first hour billed with CPT 96132.
• CPT 96136: This code is for psychological or neuropsychological test administration and scoring by a technician, rather than a physician or other qualified healthcare professional.
• CPT 96138: This code is for psychological or neuropsychological test administration and scoring by a computer, rather than a human provider.

10. Examples

Here are 10 detailed examples of CPT code 96131 procedures:

1. A patient with suspected ADHD undergoes a series of psychological tests, taking a total of 2.5 hours. The provider bills CPT 96130 for the first hour and CPT 96131 for the additional 1.5 hours.
2. A child with a suspected learning disability receives a comprehensive psychological evaluation, including cognitive, achievement, and behavioral assessments. The testing takes 3 hours, with CPT 96130 billed for the first hour and CPT 96131 billed for the additional 2 hours.
3. An adult with a history of depression undergoes a psychological evaluation to assess the severity of their symptoms and determine the appropriate treatment plan. The evaluation takes 1.5 hours, with CPT 96130 billed for the first hour and CPT 96131 billed for the additional 0.5 hours.
4. A patient with a traumatic brain injury undergoes a psychological evaluation to assess their cognitive functioning and determine the need for rehabilitation services. The evaluation takes 2 hours, with CPT 96130 billed for the first hour and CPT 96131 billed for the additional hour.
5. An individual with suspected autism spectrum disorder receives a comprehensive psychological evaluation, including assessments of social, communication, and adaptive functioning. The testing takes 4 hours, with CPT 96130 billed for the first hour and CPT 96131 billed for the additional 3 hours.
6. A patient with a history of substance abuse undergoes a psychological evaluation to assess their readiness for treatment and determine the appropriate level of care. The evaluation takes 1.5 hours, with CPT 96130 billed for the first hour and CPT 96131 billed for the additional 0.5 hours.
7. An adult with suspected bipolar disorder receives a psychological evaluation to confirm the diagnosis and develop a treatment plan. The evaluation takes 2.5 hours, with CPT 96130 billed for the first hour and CPT 96131 billed for the additional 1.5 hours.
8. A child with a history of behavioral problems undergoes a psychological evaluation to assess their emotional functioning and determine the need for therapy or other interventions. The evaluation takes 3 hours, with CPT 96130 billed for the first hour and CPT 96131 billed for the additional 2 hours.
9. An individual with a suspected personality disorder receives a comprehensive psychological evaluation, including assessments of personality traits, interpersonal functioning, and coping skills. The testing takes 2 hours, with CPT 96130 billed for the first hour and CPT 96131 billed for the additional hour.
10. A patient with a history of anxiety undergoes a psychological evaluation to assess the severity of their symptoms and determine the appropriate treatment plan. The evaluation takes 1.5 hours, with CPT 96130 billed for the first hour and CPT 96131 billed for the additional 0.5 hours.