How To Use CPT Code 96130 | Psychological Testing Evaluation Services

CPT 96130 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 96130.

1. What is CPT 96130?

CPT 96130 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 report preparation. Additionally, interactive feedback to the patient, family member(s), or caregiver(s) is included when performed. This code covers the first hour of these services.

2. 96130 CPT code description

The official description of CPT code 96130 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; first hour.”

3. Procedure

The 96130 CPT code procedure 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 detailing the test results, clinical decisions, and treatment plan.
6. Providing interactive feedback to the patient, family member(s), or caregiver(s) when performed.

This code covers the first hour of these services. Additional hours are billed using CPT 96131.

4. Qualifying circumstances

Eligible recipients of CPT code 96130 services include patients who require psychological testing for diagnostic or treatment purposes. This may include individuals with suspected or confirmed mental health disorders, learning disabilities, or other conditions that warrant psychological evaluation. The provider must be a physician or other qualified healthcare professional with the appropriate training and credentials to administer and interpret psychological tests.

5. When to use CPT code 96130

It is appropriate to bill the 96130 CPT code when a physician or other qualified healthcare professional provides psychological testing evaluation services as described in the code’s official description. This includes the integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning, report preparation, and interactive feedback to the patient, family member(s), or caregiver(s) when performed. The code covers the first hour of these services.

6. Documentation requirements

To support a claim for CPT 96130, the following information should be documented:

• The specific psychological tests administered and their relevance to the patient’s condition.
• A detailed interpretation of the test results, including any patterns or significant findings.
• Integration of the test results with other clinical data, such as medical history, symptoms, and previous treatments.
• Clinical decisions made based on the test results and other data.
• A comprehensive treatment plan, including goals, interventions, and expected outcomes.
• A report summarizing the testing process, results, clinical decisions, and treatment plan.
• Documentation of interactive feedback provided to the patient, family member(s), or caregiver(s) when performed.

7. Billing guidelines

When billing for CPT code 96130, it is important to follow the appropriate guidelines and rules. These include:

• Only billing for the first hour of psychological testing evaluation services using CPT 96130. Additional hours should be billed using CPT 96131.
• Ensuring that the provider is a physician or other qualified healthcare professional with the necessary training and credentials to administer and interpret psychological tests.
• Documenting all required information to support the claim, as outlined in the documentation requirements section.

8. Historical information

CPT 96130 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 96130

Five similar codes to CPT 96130 include:

• CPT 96131: Covers each additional hour of psychological testing evaluation services beyond the first hour.
• CPT 96132: Describes neuropsychological testing evaluation services provided by a physician or other qualified healthcare professional.
• CPT 96133: Covers each additional hour of neuropsychological testing evaluation services beyond the first hour.
• CPT 96136: Refers to psychological or neuropsychological test administration and scoring by a technician.
• CPT 96137: Covers each additional 30 minutes of psychological or neuropsychological test administration and scoring by a technician.

10. Examples

Here are 10 detailed examples of CPT code 96130 procedures:

1. A child with suspected attention deficit hyperactivity disorder (ADHD) undergoes psychological testing to aid in diagnosis and treatment planning.
2. An adult with a history of depression receives psychological testing to evaluate the severity of their symptoms and inform treatment decisions.
3. A student struggling academically undergoes psychological testing to identify potential learning disabilities and inform appropriate interventions.
4. An individual with a traumatic brain injury receives psychological testing to assess cognitive functioning and guide rehabilitation efforts.
5. A patient with a history of substance abuse undergoes psychological testing to evaluate the impact of their addiction on their mental health and inform treatment planning.
6. An individual with suspected autism spectrum disorder receives psychological testing to aid in diagnosis and inform appropriate interventions.
7. A patient with chronic pain undergoes psychological testing to evaluate the impact of their pain on their mental health and inform treatment planning.
8. An individual with a history of anxiety receives psychological testing to assess the severity of their symptoms and guide treatment decisions.
9. A patient with suspected bipolar disorder undergoes psychological testing to aid in diagnosis and inform treatment planning.
10. An adult with a history of trauma receives psychological testing to evaluate the impact of their experiences on their mental health and inform treatment planning.