CPT 96130
Global XXX ActivePsycl tst eval phys/qhp 1st
CPT 96130 Billing & Documentation Guide
CPT code 96130 (Psycl tst eval phys/qhp 1st) is classified under Psych Testing with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.56, a non-facility practice expense RVU of 1.06, and a malpractice RVU of 0.09, a total non-facility RVU of 3.71 and facility RVU of 2.98. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $126.78, though rates vary from $117.47 to $167.62 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 96130, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 96130 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 96130 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 96130
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.56 | 2.56 |
| Practice Expense RVU | 1.06 | 0.33 |
| Malpractice RVU | 0.09 | 0.09 |
| Total RVU | 3.71 | 2.98 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 96130
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $132.1 | $103.24 | $127.38 - $147.58 | 29 |
| Florida | $126.88 | $102.42 | $123.87 - $129.97 | 3 |
| Georgia | $123.01 | $99.75 | $120.67 - $125.34 | 2 |
| Illinois | $125.76 | $102.2 | $122.53 - $128.59 | 4 |
| Michigan | $122.98 | $100.09 | $121.22 - $124.74 | 2 |
| North Carolina | $120.46 | $97.71 | $120.46 - $120.46 | 1 |
| New York | $133.14 | $105.94 | $121.25 - $138.66 | 5 |
| Ohio | $120.86 | $98.6 | $120.86 - $120.86 | 1 |
| Pennsylvania | $124.17 | $100.29 | $120.85 - $127.49 | 2 |
| Texas | $123.63 | $99.62 | $120.52 - $125.8 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 96130
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 96130 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0362T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0362T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0373T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0373T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 90785 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 96110 | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
Frequently Asked Questions, CPT 96130
What does CPT code 96130 mean? +
CPT code 96130 represents: Psycl tst eval phys/qhp 1st. It's in the Psych Testing category with a global period of XXX.
What is the Medicare reimbursement for CPT 96130? +
The 2026 Medicare national average non-facility payment for CPT 96130 is $126.78. Rates range from $117.47 to $167.62 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 96130? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 96130? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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