CPT code 96130: Psychological evaluation, first hour2026 Medicare rate & RVUs

Medicare pays $123.92 for 96130 nationally in the office and $99.53 in a hospital or facility. Local office rates run $117.47–$167.62.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 96130 covers

96130 covers a physician’s or other qualified health care professional’s psychological testing evaluation: integrating interview and record information with test findings, interpreting standardized measures, applying clinical judgment, planning treatment, and preparing a report. Psychologists and other qualified clinicians perform this work in outpatient practices, hospitals, and other settings where psychological assessment is provided. The evaluation and interpretation are distinct from administering the tests themselves.

Report 96130 for the first hour of the evaluation service; report 96131 for additional evaluation time. Documentation should identify the assessment question, relevant clinical and test data, interpretive conclusions, decisions, recommendations, and time attributable to the service. Test administration and scoring may be reported separately with 96136 when performed by a physician or qualified health care professional, or 96138 when performed by a technician; document that work separately from the evaluation. Use 96132 or 96133 for a neuropsychological testing evaluation.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 96130 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

96130 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 96130 rate is calculated

Each of 96130’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 96130

96130 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

96130 compared with similar codes

How to choose

96131Psychological testingEach additional hour

96130 reports the first hour of psychological testing evaluation; 96131 reports additional evaluation time.

96132Neuropsychological evaluationFirst hour

Choose 96130 for psychological testing evaluation and 96132 when the evaluation is neuropsychological.

96136Test administrationPhysician or QHP, first 30 minutes

96130 covers evaluation, interpretation, and treatment planning; 96136 covers test administration and scoring by a physician or qualified health care professional.

96138Psychological testingTechnician, first 30 minutes

96130 covers the professional evaluation of test information; 96138 covers test administration and scoring performed by a technician.

Codes related to 96130

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates