The 96130 CPT code is a critical billing code for mental health services, and knowing how to use it correctly ensures compliance and maximizes reimbursement.
That’s why we will provide you with all the answers to common questions about the 96130 CPT code, including eligibility, time requirements, billing practices, and more.
What Is 96130 CPT Code?
96130 CPT code is used to report the first 30 minutes of psychological testing services provided by a qualified healthcare professional.
These services include the administration of tests, scoring, interpretation, and reporting. It ensures comprehensive evaluation and supports the treatment planning process.
Is 96130 CPT Code Time-Based? How Much Time Is Required?
Yes, the 96130 CPT code is time-based. It represents the first 30 minutes of psychological testing services.
This includes activities such as:
- Selecting appropriate tests
- Administering and scoring tests
- Interpreting results
- Preparing a report
What Happens If Time Exceeds 30 Minutes?
For every additional 30 minutes beyond the first, you should bill CPT 96131 (each additional unit of testing time). Proper documentation of the total time spent is essential to justify the additional code.
How Often Can 96130 CPT Code Be Billed?
The frequency of billing depends on the patient’s medical necessity and payer policies. For example, Medicare may allow testing once per year unless there is a significant change in the patient’s condition.
Who Can Bill 96130 CPT Code?
CPT 96130 is billable by:
- Physicians, such as Family Practice MDs and Pediatric NPs
- Physician Assistants (PAs) in Internal Medicine
- Licensed Clinical Psychologists
Therapists, non-clinical social workers, and unlicensed professionals cannot bill this code. A behavioral health specialty is not required, but the billing professional must meet the necessary qualifications.
Which ICD-10 Codes Can Be Used with CPT 96130?
Appropriate ICD-10 codes will depend on the patient’s condition and the purpose of testing.
Commonly used codes include those for:
- Mental health conditions like depression (F32.9) or anxiety (F41.9)
- Developmental disorders such as ADHD (F90.9)
- Neurological conditions like dementia (F03.90)
Always confirm ICD-10 compatibility with payer-specific guidelines.
What Modifier Should Be Used for CPT 96130?
Modifiers such as -59 (Distinct Procedural Service) or -25 (Significant, Separately Identifiable Evaluation and Management Service) may be required depending on the circumstances.
Always check with the payer to determine the correct modifier.
Simplify the Billing Process with Medical Claims Billing
Billing for CPT code 96130 can be complicated, with specific rules about time, codes, and modifiers. Managing these details takes time and energy – time that could be better spent caring for your patients.
But it doesn’t have to be like that because Medical Claims Billing can take care of the whole billing process. We make sure your claims are accurate and follow the latest regulations, so you get paid quickly and correctly.
Get in touch to see how we can make billing simple and stress-free for your practice.
