CPT code 96130: Psychological evaluation, first hour2026 Medicare rate & RVUs in Missouri
Reports the first hour of a physician’s or qualified health care professional’s psychological testing evaluation, including interpretation, clinical decisions, treatment planning, and a report.
Medicare pays $118.95–$122.22 for 96130 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
Your location
On this page 9 sections
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 in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$118.95 to $122.22
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $121.69 | $98.79 |
| Metropolitan St. Louis, MO | $122.22 | $99.01 |
| Rest of Missouri | $118.95 | $97.94 |
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.
How the rate is built · 96130
RVUs × geographic indexes × conversion factor
Work2.56
2.56 RVUs× 1.000 GPCI
Practice expense1.06
1.06 RVUs× 1.000 GPCI
Malpractice0.09
0.09 RVUs× 1.000 GPCI
Adjusted RVUs
3.7100
Conversion factor
$33.4009
Medicare rate
$123.92
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
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.
Place of service · 96130
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$123.92
- Non-facility (office)
- $123.92
- Facility
- $99.53
Higher because the practice carries its own overhead.
96130 compared with similar codes
Compare codes · National
5 codes, side by side
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.
96130 billing questions
How does 96130 differ from 96132?
96130 represents a psychological testing evaluation. Use 96132 for a neuropsychological testing evaluation, which focuses on neurocognitive functioning.
Does 96130 include test administration and scoring?
The evaluation includes interpretation and clinical decision-making, not the administration and scoring work itself. That work may be reported separately with 96136 or 96138, depending on who performs it.
When is 96131 reported with 96130?
96130 represents the first hour of psychological testing evaluation, and 96131 represents additional evaluation time. The documentation should support the time and evaluation work reported.
What documentation supports 96130?
Document the reason for assessment, the clinical and test information considered, interpretation, clinical conclusions, treatment recommendations, and time spent on the evaluation.
Can 96130 be reported with 96136 or 96138?
They represent different work: 96130 is the evaluation, while 96136 and 96138 represent test administration and scoring by a physician or qualified health care professional, or a technician, respectively. Document each 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
Show the CMS file lines behind this rate
Fee sheets
Put 96130 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Build my fee sheet