Billing Guidance for Neurological / Psychological Testing
Billing Guidance for Neurological / Psychological Testing
According to the HCPF newsletter, the announcement below provides the correct, current billing requirements for psychological evaluation and testing services to ensure correct payments. Their recent newsletter stated that the newsletter announcement sent out February 2026 included inaccurate and unclear information.
The following Current Procedural Terminology (CPT) codes are the only codes applicable to neurological / psychological testing:
96130 - Psychological testing evaluation by physician or other qualified health care professional with interactive feedback to member, family member(s) or caregiver(s), when performed; first 60 mins
96131 - ADD-ON Psychological testing evaluation services by physician or other qualified health care professional; each add’l 60 mins
96136 - Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 mins
96137 - ADD-ON Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; each add’l 30 mins
When billing the codes listed above, for payment under fee-for-service (FFS), Rocky Mountain Health Plans PRIME (Rocky), or Denver Health Medical Plan (Denver Health), providers must use the SC modifier.
When billing the codes listed above, for payment from the RAEs, providers must NOT use the SC modifier.
Claims billed under FFS, without the SC modifier will deny and direct the provider to bill the RAE. Claims that do not follow this process when billing will need to be resubmitted.
REMINDER: Use of the above CPT codes does NOT require a covered diagnosis.
Office hours are held regularly for providers to come with billing questions or to receive additional clarification. Providers may also contact hcpf_bhbenefits@state.co.us.
Note our lobbyists will be contacting HCPF for clarification on the use of codes 90791, 96132, 96133, 96138, and 96139, which are legitimate, and potentially more appropriate codes, depending on the nature of the testing and who delivers the service. These codes are missing from their newsletter guidance.