$84.82
96130 reports the first hour of psychological testing evaluation; 96131 reports additional evaluation time.
On this page
CMS RVU26D · Effective 2026-10-01
96130 Psychological evaluation Medicare reimbursement rates in Indiana
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. Compare 96130 office and facility rates across CMS payment localities in Indiana.
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 96130 in Indiana?
Indiana 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
$119.79
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
Facility setting
$97.18
1 of 1 localities have a supported rate.
Payment area: Indiana
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 96130: Psychological testing evaluation
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.
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.
Where the value comes from
- Work RVU2.56 · 69%
- Practice expense (office) RVU1.06 · 29%
- Malpractice RVU0.09 · 2%
125.2K
Medicare services in 2024 · #502 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.
96130 compared with similar codes
Office rates for Indiana, from the same CMS release.
$118.53
Choose 96130 for psychological testing evaluation and 96132 when the evaluation is neuropsychological.
$41.61
96130 covers evaluation, interpretation, and treatment planning; 96136 covers test administration and scoring by a physician or qualified health care professional.
$34.84
96130 covers the professional evaluation of test information; 96138 covers test administration and scoring performed by a technician.
Compare 96130 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
Indiana →
Office / nonfacility
$119.79
Facility
$97.18
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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 96130 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
12,755
- Code
- 96130
- Physician work
- 2.56
- Practice expense
- 1.06
- Malpractice
- 0.09
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.56 | × 1.000 | 2.5600 |
| Practice expense | 1.06 | × 0.927 | 0.9826 |
| Malpractice | 0.09 | × 0.486 | 0.0437 |
| Total RVUs | 3.5864 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Indiana$119.79
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.56 | 1 |
| Practice expense | 1.06 | 0.927 |
| Malpractice | 0.09 | 0.486 |
(2.56 × 1 + 1.06 × 0.927 + 0.09 × 0.486) × $33.4009 = $119.79
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.56 | 1 |
| Practice expense | 0.33 | 0.927 |
| Malpractice | 0.09 | 0.486 |
(2.56 × 1 + 0.33 × 0.927 + 0.09 × 0.486) × $33.4009 = $97.18
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.
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 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.
12,75296121,,Nubhvl xm phy/qhp ea addl hr,A,,1.71,0.54,,0.12,,0.01,2.26,1.84,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,04,0,99,0.00,0.00,0.00
12,75396125,,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
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915