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CMS RVU26D · Effective 2026-10-01

96131 in Modesto

Office / nonfacility

$89.45

Base rate per service

Facility setting

$71.52

Base rate per service

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

Psychological testing

About 96131: Additional psychological testing evaluation hour

Report 96131 for additional physician or qualified professional time interpreting psychological test findings, integrating clinical information, and preparing an evaluation after the initial hour.

96131 represents additional physician or qualified health professional time for psychological testing evaluation after the initial hour. The clinician integrates test results with interview findings, records, and other clinical information; interprets findings; makes clinical decisions; develops treatment recommendations; and prepares a report. Feedback to the patient, family, or caregiver is part of the evaluation when performed. Psychologists and other qualified professionals use this service in office and facility settings to address diagnostic questions involving emotional, behavioral, personality, or intellectual functioning.

Report 96131 only with 96130, which represents the initial hour. Choose additional units based on documented evaluation time, not the number of tests or instruments; the record should support the professional work performed and the resulting report. CMS identifies this add-on as paid within the primary procedure's global period. Test administration and scoring are distinct work from evaluation and may be reported with the applicable administration codes when their requirements are met.

CMS billing rules for 96131

Global period
Add-on code: billed only together with a primary procedure and paid within that procedure's global period.

Where the value comes from

  • Work RVU1.96 · 76%
  • Practice expense (office) RVU0.62 · 24%
  • Malpractice RVU0.01 · 0%

73.5K

Medicare services in 2024 · #653 by national volume

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.

96131 compared with similar codes

Office rates for Modesto, from the same CMS release.

96130

Psychological evaluation

First hour

$127.38

96130 reports the initial hour of psychological testing evaluation. Use 96131 only for additional evaluation time and report it with 96130.

96133

Neuropsychological evaluation

Each additional hour

$101.71

96133 is additional time for neuropsychological testing evaluation and is paired with 96132. 96131 is for psychological testing evaluation and is paired with 96130.

96137

Test administration

Additional physician/QHP time

$39.42

96137 covers additional test administration and scoring by a physician or qualified health professional; 96131 covers additional evaluation work, such as interpretation and reporting.

96139

Psychology testing

Technician, each additional 30 minutes

$38.80

96139 covers additional test administration and scoring by a technician. 96131 is for additional physician or qualified professional evaluation time.

The same code, a different location

How does Modesto compare?

In Bakersfield, the office rate for 96131 is $89.61—$0.16 higher than the $89.45 rate in Modesto. Both use the same code, release and participation basis.

96131 across payment areas

Same release and payment basis · bars start at $0

  1. Modesto · This locality

    $89.45

  2. Bakersfield

    $89.61

    $0.16 higher than Modesto

  3. Chico

    $89.45

    The same base rate than Modesto

  4. El Centro

    $89.46

    $0.01 higher than Modesto

  5. Fresno

    $89.45

    The same base rate than Modesto

  6. Hanford-Corcoran

    $89.45

    The same base rate than Modesto

  7. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $92.87

    $3.42 higher than Modesto

Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 96131 ranges from $83.43 in Arkansas to $120.44 in Alaska*. This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Madera

    California · 96131

    Office

    $89.45

    Facility

    $71.52

    The same base rate than Modesto for the office setting.

  • Merced

    California · 96131

    Office

    $89.45

    Facility

    $71.52

    The same base rate than Modesto for the office setting.

  • Napa

    California · 96131

    Office

    $97.05

    Facility

    $75.48

    $7.60 higher than Modesto for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 96131

    Office

    $91.98

    Facility

    $72.64

    $2.53 higher than Modesto for the office setting.

  • Redding

    California · 96131

    Office

    $89.45

    Facility

    $71.52

    The same base rate than Modesto for the office setting.

  • Rest Of California

    California · 96131

    Office

    $89.45

    Facility

    $71.52

    The same base rate than Modesto for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 96131

    Office

    $89.63

    Facility

    $71.69

    $0.18 higher than Modesto for the office setting.

  • Sacramento-Roseville-Folsom

    California · 96131

    Office

    $92.09

    Facility

    $73.05

    $2.64 higher than Modesto for the office setting.

  • Salinas

    California · 96131

    Office

    $91.68

    Facility

    $72.71

    $2.23 higher than Modesto for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 96131

    Office

    $92.38

    Facility

    $72.80

    $2.93 higher than Modesto for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 96131

    Office

    $101.04

    Facility

    $77.96

    $11.59 higher than Modesto for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 96131

    Office

    $101.03

    Facility

    $77.95

    $11.58 higher than Modesto for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 96131

    Office

    $102.71

    Facility

    $79.11

    $13.26 higher than Modesto for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 96131

    Office

    $102.66

    Facility

    $79.06

    $13.21 higher than Modesto for the office setting.

  • San Luis Obispo-Paso Robles

    California · 96131

    Office

    $90.34

    Facility

    $71.70

    $0.89 higher than Modesto for the office setting.

  • Santa Cruz-Watsonville

    California · 96131

    Office

    $92.18

    Facility

    $72.30

    $2.73 higher than Modesto for the office setting.

  • Santa Maria-Santa Barbara

    California · 96131

    Office

    $91.62

    Facility

    $72.54

    $2.17 higher than Modesto for the office setting.

  • Santa Rosa-Petaluma

    California · 96131

    Office

    $93.04

    Facility

    $72.94

    $3.59 higher than Modesto for the office setting.

  • Stockton

    California · 96131

    Office

    $89.45

    Facility

    $71.52

    The same base rate than Modesto for the office setting.

  • Vallejo

    California · 96131

    Office

    $97.04

    Facility

    $75.47

    $7.59 higher than Modesto for the office setting.

  • Visalia

    California · 96131

    Office

    $89.45

    Facility

    $71.52

    The same base rate than Modesto for the office setting.

  • Yuba City

    California · 96131

    Office

    $89.45

    Facility

    $71.52

    The same base rate than Modesto for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 96131

    Office

    $93.77

    Facility

    $74.49

    $4.32 higher than Modesto for the office setting.

  • Miami

    Florida · 96131

    Office

    $87.87

    Facility

    $70.83

    $1.58 lower than Modesto for the office setting.

  • Chicago

    Illinois · 96131

    Office

    $87.50

    Facility

    $71.05

    $1.95 lower than Modesto for the office setting.

  • Manhattan

    New York · 96131

    Office

    $94.25

    Facility

    $75.23

    $4.80 higher than Modesto for the office setting.

  • Alaska*

    Alaska · 96131

    Office

    $120.44

    Facility

    $103.01

    $30.99 higher than Modesto for the office setting.

  • Alabama

    Alabama · 96131

    Office

    $83.77

    Facility

    $69.45

    $5.68 lower than Modesto for the office setting.

  • Arkansas

    Arkansas · 96131

    Office

    $83.43

    Facility

    $69.37

    $6.02 lower than Modesto for the office setting.

  • Arizona

    Arizona · 96131

    Office

    $85.82

    Facility

    $69.96

    $3.63 lower than Modesto for the office setting.

  • Colorado

    Colorado · 96131

    Office

    $88.55

    Facility

    $71.13

    $0.90 lower than Modesto for the office setting.

  • Connecticut

    Connecticut · 96131

    Office

    $89.48

    Facility

    $71.86

    $0.03 higher than Modesto for the office setting.

  • Delaware

    Delaware · 96131

    Office

    $86.55

    Facility

    $70.38

    $2.90 lower than Modesto for the office setting.

  • Fort Lauderdale

    Florida · 96131

    Office

    $87.05

    Facility

    $70.47

    $2.40 lower than Modesto for the office setting.

  • Rest Of Florida

    Florida · 96131

    Office

    $85.77

    Facility

    $70.12

    $3.68 lower than Modesto for the office setting.

  • Atlanta

    Georgia · 96131

    Office

    $87.10

    Facility

    $70.47

    $2.35 lower than Modesto for the office setting.

  • Rest Of Georgia

    Georgia · 96131

    Office

    $84.34

    Facility

    $69.74

    $5.11 lower than Modesto for the office setting.

  • Hawaii, Guam

    Hawaii · 96131

    Office

    $89.20

    Facility

    $70.60

    $0.25 lower than Modesto for the office setting.

  • Iowa

    Iowa · 96131

    Office

    $84.55

    Facility

    $69.57

    $4.90 lower than Modesto for the office setting.

  • Idaho

    Idaho · 96131

    Office

    $84.68

    Facility

    $69.62

    $4.77 lower than Modesto for the office setting.

  • East St. Louis

    Illinois · 96131

    Office

    $85.19

    Facility

    $70.13

    $4.26 lower than Modesto for the office setting.

  • Rest Of Illinois

    Illinois · 96131

    Office

    $84.89

    Facility

    $69.95

    $4.56 lower than Modesto for the office setting.

  • Suburban Chicago

    Illinois · 96131

    Office

    $87.78

    Facility

    $70.98

    $1.67 lower than Modesto for the office setting.

  • Indiana

    Indiana · 96131

    Office

    $84.82

    Facility

    $69.65

    $4.63 lower than Modesto for the office setting.

  • Kansas

    Kansas · 96131

    Office

    $84.35

    Facility

    $69.56

    $5.10 lower than Modesto for the office setting.

  • Kentucky

    Kentucky · 96131

    Office

    $84.18

    Facility

    $69.63

    $5.27 lower than Modesto for the office setting.

  • New Orleans

    Louisiana · 96131

    Office

    $85.33

    Facility

    $69.93

    $4.12 lower than Modesto for the office setting.

  • Rest Of Louisiana

    Louisiana · 96131

    Office

    $84.11

    Facility

    $69.63

    $5.34 lower than Modesto for the office setting.

  • Metropolitan Boston

    Massachusetts · 96131

    Office

    $93.17

    Facility

    $73.63

    $3.72 higher than Modesto for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 96131

    Office

    $88.59

    Facility

    $71.35

    $0.86 lower than Modesto for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 96131

    Office

    $89.15

    Facility

    $71.59

    $0.30 lower than Modesto for the office setting.

  • Rest Of Maryland

    Maryland · 96131

    Office

    $87.38

    Facility

    $70.82

    $2.07 lower than Modesto for the office setting.

  • Rest Of Maine

    Maine · 96131

    Office

    $84.73

    Facility

    $69.67

    $4.72 lower than Modesto for the office setting.

  • Southern Maine

    Maine · 96131

    Office

    $86.20

    Facility

    $69.98

    $3.25 lower than Modesto for the office setting.

  • Detroit

    Michigan · 96131

    Office

    $86.01

    Facility

    $70.22

    $3.44 lower than Modesto for the office setting.

  • Rest Of Michigan

    Michigan · 96131

    Office

    $84.75

    Facility

    $69.81

    $4.70 lower than Modesto for the office setting.

  • Minnesota

    Minnesota · 96131

    Office

    $86.87

    Facility

    $70.03

    $2.58 lower than Modesto for the office setting.

  • Metropolitan Kansas City

    Missouri · 96131

    Office

    $85.24

    Facility

    $69.87

    $4.21 lower than Modesto for the office setting.

  • Metropolitan St. Louis

    Missouri · 96131

    Office

    $85.51

    Facility

    $69.93

    $3.94 lower than Modesto for the office setting.

  • Rest Of Missouri

    Missouri · 96131

    Office

    $83.64

    Facility

    $69.53

    $5.81 lower than Modesto for the office setting.

  • Mississippi

    Mississippi · 96131

    Office

    $83.54

    Facility

    $69.45

    $5.91 lower than Modesto for the office setting.

  • Montana**

    Montana · 96131

    Office

    $86.51

    Facility

    $70.14

    $2.94 lower than Modesto for the office setting.

  • North Carolina

    North Carolina · 96131

    Office

    $85.00

    Facility

    $69.73

    $4.45 lower than Modesto for the office setting.

  • North Dakota**

    North Dakota · 96131

    Office

    $86.31

    Facility

    $69.94

    $3.14 lower than Modesto for the office setting.

  • Nebraska

    Nebraska · 96131

    Office

    $84.71

    Facility

    $69.60

    $4.74 lower than Modesto for the office setting.

  • New Hampshire

    New Hampshire · 96131

    Office

    $87.32

    Facility

    $70.28

    $2.13 lower than Modesto for the office setting.

  • Northern Nj

    New Jersey · 96131

    Office

    $93.97

    Facility

    $74.98

    $4.52 higher than Modesto for the office setting.

  • Rest Of New Jersey

    New Jersey · 96131

    Office

    $91.06

    Facility

    $73.19

    $1.61 higher than Modesto for the office setting.

  • New Mexico

    New Mexico · 96131

    Office

    $84.86

    Facility

    $69.85

    $4.59 lower than Modesto for the office setting.

  • Nevada**

    Nevada · 96131

    Office

    $86.47

    Facility

    $70.09

    $2.98 lower than Modesto for the office setting.

  • Nyc Suburbs/Long Island

    New York · 96131

    Office

    $94.90

    Facility

    $75.44

    $5.45 higher than Modesto for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 96131

    Office

    $91.49

    Facility

    $73.57

    $2.04 higher than Modesto for the office setting.

  • Queens

    New York · 96131

    Office

    $94.61

    Facility

    $75.27

    $5.16 higher than Modesto for the office setting.

  • Rest Of New York

    New York · 96131

    Office

    $85.37

    Facility

    $69.83

    $4.08 lower than Modesto for the office setting.

  • Ohio

    Ohio · 96131

    Office

    $84.71

    Facility

    $69.77

    $4.74 lower than Modesto for the office setting.

  • Oklahoma

    Oklahoma · 96131

    Office

    $84.22

    Facility

    $69.60

    $5.23 lower than Modesto for the office setting.

  • Portland

    Oregon · 96131

    Office

    $89.77

    Facility

    $71.59

    $0.32 higher than Modesto for the office setting.

  • Rest Of Oregon

    Oregon · 96131

    Office

    $86.33

    Facility

    $70.03

    $3.12 lower than Modesto for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 96131

    Office

    $88.60

    Facility

    $71.56

    $0.85 lower than Modesto for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 96131

    Office

    $84.79

    Facility

    $69.77

    $4.66 lower than Modesto for the office setting.

  • Puerto Rico

    Puerto Rico · 96131

    Office

    $86.73

    Facility

    $70.18

    $2.72 lower than Modesto for the office setting.

  • Rhode Island

    Rhode Island · 96131

    Office

    $88.40

    Facility

    $71.49

    $1.05 lower than Modesto for the office setting.

  • South Carolina

    South Carolina · 96131

    Office

    $84.88

    Facility

    $69.76

    $4.57 lower than Modesto for the office setting.

  • South Dakota**

    South Dakota · 96131

    Office

    $86.29

    Facility

    $69.92

    $3.16 lower than Modesto for the office setting.

  • Tennessee

    Tennessee · 96131

    Office

    $84.47

    Facility

    $69.59

    $4.98 lower than Modesto for the office setting.

  • Austin

    Texas · 96131

    Office

    $87.80

    Facility

    $70.49

    $1.65 lower than Modesto for the office setting.

  • Beaumont

    Texas · 96131

    Office

    $84.62

    Facility

    $69.73

    $4.83 lower than Modesto for the office setting.

  • Brazoria

    Texas · 96131

    Office

    $86.77

    Facility

    $70.55

    $2.68 lower than Modesto for the office setting.

  • Dallas

    Texas · 96131

    Office

    $86.97

    Facility

    $70.67

    $2.48 lower than Modesto for the office setting.

  • Fort Worth

    Texas · 96131

    Office

    $86.76

    Facility

    $70.63

    $2.69 lower than Modesto for the office setting.

  • Galveston

    Texas · 96131

    Office

    $86.83

    Facility

    $70.58

    $2.62 lower than Modesto for the office setting.

  • Houston

    Texas · 96131

    Office

    $87.01

    Facility

    $70.76

    $2.44 lower than Modesto for the office setting.

  • Rest Of Texas

    Texas · 96131

    Office

    $85.42

    Facility

    $69.89

    $4.03 lower than Modesto for the office setting.

  • Utah

    Utah · 96131

    Office

    $85.23

    Facility

    $69.85

    $4.22 lower than Modesto for the office setting.

  • Virginia

    Virginia · 96131

    Office

    $86.06

    Facility

    $69.97

    $3.39 lower than Modesto for the office setting.

  • Virgin Islands

    United States Virgin Islands · 96131

    Office

    $86.73

    Facility

    $70.18

    $2.72 lower than Modesto for the office setting.

  • Vermont

    Vermont · 96131

    Office

    $86.14

    Facility

    $69.93

    $3.31 lower than Modesto for the office setting.

  • Rest Of Washington

    Washington · 96131

    Office

    $88.38

    Facility

    $71.14

    $1.07 lower than Modesto for the office setting.

  • Seattle (King Cnty)

    Washington · 96131

    Office

    $94.42

    Facility

    $74.34

    $4.97 higher than Modesto for the office setting.

  • Wisconsin

    Wisconsin · 96131

    Office

    $85.41

    Facility

    $69.73

    $4.04 lower than Modesto for the office setting.

  • West Virginia

    West Virginia · 96131

    Office

    $83.94

    Facility

    $69.72

    $5.51 lower than Modesto for the office setting.

  • Wyoming**

    Wyoming · 96131

    Office

    $86.42

    Facility

    $70.06

    $3.03 lower than Modesto for the office setting.

See how rates vary across the country

96131 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$83.43

$120.44

Color shows the midpoint of each state’s locality range.

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$120.441
AL$83.771
AR$83.431
AZ$85.821
CA$89.45–$102.7129
CO$88.551
CT$89.481
DC$93.771
DE$86.551
FL$85.77–$87.873
GA$84.34–$87.102
GU$89.201
HI$89.201
IA$84.551
ID$84.681
IL$84.89–$87.784
IN$84.821
KS$84.351
KY$84.181
LA$84.11–$85.332
MA$88.59–$93.172
MD$87.38–$93.773
ME$84.73–$86.202
MI$84.75–$86.012
MN$86.871
MO$83.64–$85.513
MS$83.541
MT$86.511
NC$85.001
ND$86.311
NE$84.711
NH$87.321
NJ$91.06–$93.972
NM$84.861
NV$86.471
NY$85.37–$94.905
OH$84.711
OK$84.221
OR$86.33–$89.772
PA$84.79–$88.602
PR$86.731
RI$88.401
SC$84.881
SD$86.291
TN$84.471
TX$84.62–$87.808
UT$85.231
VA$86.06–$93.772
VI$86.731
VT$86.141
WA$88.38–$94.422
WI$85.411
WV$83.941
WY$86.421

Explore 96131 on the national rate map →

Where does this rate apply?

Modesto is a Medicare payment area. Our Census mapping connects it to 33 cities and communities in California, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in California →

Why are the office and facility amounts different?

For 96131 in Modesto, the physician’s office rate is $89.45 and the facility-setting rate is $71.52: a difference of $17.93.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 96131 in Modesto. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$98.40

$89.45 × 110% = $98.40

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

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How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 96131 in Modesto.

PPRRVU2026_Oct_nonQPP.csv

12,756

Code
96131
Physician work
1.96
Practice expense
0.62
Malpractice
0.01

GPCI2026.csv

16

Locality
Modesto
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 96131 in Modesto
ComponentRVULocality factorAdjusted
Physician work1.96× 1.0171.9933
Practice expense0.62× 1.0960.6795
Malpractice0.01× 0.5360.0054
Total RVUs2.6782
Conversion factor× 33.4009

Office / nonfacility rate, Modesto$89.45

Open 96131 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work1.961.017
Practice expense0.621.096
Malpractice0.010.536

(1.96 × 1.017 + 0.62 × 1.096 + 0.01 × 0.536) × $33.4009 = $89.45

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work1.961.017
Practice expense0.131.096
Malpractice0.010.536

(1.96 × 1.017 + 0.13 × 1.096 + 0.01 × 0.536) × $33.4009 = $71.52

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

96131 · Office / nonfacility

$89.45

Effective 2026-10-01

The base rate is $4.64 higher than on 2025-10-01, moving from $84.81 to $89.45 (5.5%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $84.81changed to$89.45

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 0.56 changed to 0.62
    • Malpractice RVU 0.04 changed to 0.01
    • Work GPCI 1.014 changed to 1.017
    • Practice expense GPCI 1.093 changed to 1.096
    • Malpractice GPCI 0.560 changed to 0.536

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $84.81

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$89.45$71.52RVU26D
2026-07-01$89.45$71.52RVU26C
2026-04-01$89.45$71.52RVU26B
2026-01-01$89.45$71.52RVU26A
2025-10-01$84.81$73.50RVU25D
2025-07-01$84.81$73.50RVU25C
2025-04-01$84.81$73.50RVU25B
2025-01-01$84.81$73.50RVU25A

96131 billing questions

Can 96131 be reported by itself?

No. It is an add-on code and must be reported with 96130 for the initial hour of psychological testing evaluation.

How is the number of 96131 units determined?

Use the documented additional evaluation time, rather than the number of tests administered. The record should support the time spent on interpretation, integration, clinical decision-making, recommendations, and reporting.

Does 96131 include test administration and scoring?

No. Evaluation work is distinct from administering and scoring tests. When separately reportable, administration and scoring use the applicable physician/QHP or technician codes.

How does 96131 differ from 96133?

96131 is additional time for psychological testing evaluation. 96133 is additional time for neuropsychological testing evaluation, paired with its own initial-hour code, 96132.

What documentation supports 96131?

Document the additional professional evaluation time and the work performed, such as integrating test findings with clinical information, interpreting results, developing recommendations, and completing the report.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 96131PPRRVU2026_Oct_nonQPP.csv, line 12,756 (RVU26D)
Geographic factors for ModestoGPCI2026.csv, line 16 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet