The 96131 CPT code is used for psychological or neuropsychological testing services that include a neurobehavioral status exam, with interpretation, clinical decision-making, and report preparation.
It is an add-on code, meaning it is billed in conjunction with another primary testing code, such as 96130, which covers the first hour of such testing.
When Should You Use 96131 CPT Code?
Understanding the proper application of 96131 CPT code ensures accurate billing and compliance with payer requirements. You should use 96131 CPT code:
- In conjunction with 96130. Start by billing 96130 for the first hour of evaluation services.
- For additional hours. Use 96131 for every additional hour of service provided beyond the initial hour.
- Comprehensive assessments. Particularly for complex cases requiring extended evaluation, such as determining the impact of neurodegenerative diseases, ADHD assessments, or post-stroke cognitive evaluations.
Example Scenario
Let’s say a psychologist conducts a neuropsychological evaluation for a patient suspected of having a learning disorder. The testing session lasts for 2 hours and 30 minutes. Here’s how you would code the session:
- 96130 for the first hour.
- 96131 (x2) for the additional two hours.
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Documentation Requirements
The following paperwork must be provided by practitioners in order to guarantee proper reimbursement:
- The specific tests performed.
- The time spent on administration, interpretation, and reporting.
- The clinical necessity of extended testing.
Failing to meet documentation standards can result in claim denials or audits.
Why is 96131 CPT Code Important?
96131 CPT code highlights the intricate and time-intensive nature of psychological and neuropsychological evaluations.
These assessments:
- Provide critical insights into cognitive and emotional functioning.
- Guide treatment planning for a wide range of mental health and neurological conditions.
- Support accurate diagnosis and better patient outcomes.
Reimbursement Rate for 96131 CPT Code
The reimbursement rate for CPT code 96131 is $84.15. This reflects the compensation for each additional hour of psychological or neuropsychological testing, following the initial hour billed under CPT code 96130.
While rates may vary depending on the payer and your location, this standardized amount highlights the value placed on extended assessment services essential for accurate diagnoses and treatment planning.
