$126.55
96130 reports the initial hour of psychological testing evaluation. Use 96131 only for additional evaluation time and report it with 96130.
On this page
CMS RVU26D · Effective 2026-10-01
96131 Psychological testing Medicare reimbursement rates in Colorado
Report 96131 for additional physician or qualified professional time interpreting psychological test findings, integrating clinical information, and preparing an evaluation after the initial hour. Compare 96131 office and facility rates across CMS payment localities in Colorado.
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.
What does Medicare pay for 96131 in Colorado?
Colorado has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$88.55
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
Facility setting
$71.13
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
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 Colorado, from the same CMS release.
$100.53
96133 is additional time for neuropsychological testing evaluation and is paired with 96132. 96131 is for psychological testing evaluation and is paired with 96130.
$38.65
96137 covers additional test administration and scoring by a physician or qualified health professional; 96131 covers additional evaluation work, such as interpretation and reporting.
$37.67
96139 covers additional test administration and scoring by a technician. 96131 is for additional physician or qualified professional evaluation time.
Compare 96131 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Colorado →
Office / nonfacility
$88.55
Facility
$71.13
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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 Colorado.
PPRRVU2026_Oct_nonQPP.csv
12,756
- Code
- 96131
- Physician work
- 1.96
- Practice expense
- 0.62
- Malpractice
- 0.01
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.96 | × 1.012 | 1.9835 |
| Practice expense | 0.62 | × 1.064 | 0.6597 |
| Malpractice | 0.01 | × 0.781 | 0.0078 |
| Total RVUs | 2.6510 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Colorado$88.55
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.96 | 1.012 |
| Practice expense | 0.62 | 1.064 |
| Malpractice | 0.01 | 0.781 |
(1.96 × 1.012 + 0.62 × 1.064 + 0.01 × 0.781) × $33.4009 = $88.55
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.96 | 1.012 |
| Practice expense | 0.13 | 1.064 |
| Malpractice | 0.01 | 0.781 |
(1.96 × 1.012 + 0.13 × 1.064 + 0.01 × 0.781) × $33.4009 = $71.13
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.
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.
12,75396125,,Cognitive test by hc pro,A,,1.70,1.34,,1.34,NA,0.04,3.08,3.08,7,XXX,0.00,0.00,0.00,5,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,75496127,,Brief emotional/behav assmt,A,,0.00,0.14,,0.14,NA,0.01,0.15,0.15,3,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,75596130,,Psycl tst eval phys/qhp 1st,A,,2.56,1.06,,0.33,,0.09,3.71,2.98,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,04,0,99,0.00,0.00,0.00
12,75696131,,Psycl tst eval phys/qhp ea,A,,1.96,0.62,,0.13,,0.01,2.59,2.10,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,04,0,99,0.00,0.00,0.00
12,75796132,,Nrpsyc tst eval phys/qhp 1st,A,,2.56,1.03,,0.32,,0.07,3.66,2.95,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,04,0,99,0.00,0.00,0.00
12,75896133,,Nrpsyc tst eval phys/qhp ea,A,,1.96,0.95,,0.13,,0.02,2.93,2.11,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,04,0,99,0.00,0.00,0.00
12,75996136,,Psycl/nrpsyc tst phy/qhp 1st,A,,0.55,0.74,,0.07,,0.02,1.31,0.64,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,04,0,99,0.00,0.00,0.00
3401112,CA,69,VISALIA,1.017,1.096,0.536
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899