Billing code 96131: Psychological testingMedicare rate & RVUs in Illinois
Report 96131 for additional physician or qualified professional time interpreting psychological test findings, integrating clinical information, and preparing an evaluation after the initial hour.
Medicare pays $84.89–$87.78 for 96131 in the office in Illinois, from Rest Of Illinois to Suburban Chicago. 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.
On this page 9 sections
What 96131 covers
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.
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 96131 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$84.89 to $87.78
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $87.50 | $71.05 |
| East St. Louis | $85.19 | $70.13 |
| Rest Of Illinois | $84.89 | $69.95 |
| Suburban Chicago | $87.78 | $70.98 |
How the 96131 rate is calculated
Each of 96131’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 · 96131
RVUs × geographic indexes × conversion factor
Work1.96
1.96 RVUs× 1.000 GPCI
Practice expense0.62
0.62 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
2.5900
Conversion factor
$33.4009
Medicare rate
$86.51
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 96131
The CMS indicators that decide how 96131 is paid alongside other services.
CMS payment indicators · 96131
Psychological testing
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
96131 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 96130Psychological evaluation
- 96130 reports the initial hour of psychological testing evaluation. Use 96131 only for additional evaluation time and report it with 96130.
- 96133Neuropsychological evaluation
- 96133 is additional time for neuropsychological testing evaluation and is paired with 96132. 96131 is for psychological testing evaluation and is paired with 96130.
- 96137Test administration
- 96137 covers additional test administration and scoring by a physician or qualified health professional; 96131 covers additional evaluation work, such as interpretation and reporting.
- 96139Psychology testing
- 96139 covers additional test administration and scoring by a technician. 96131 is for additional physician or qualified professional evaluation time.
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 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
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