CPT 96131
Global ZZZ ActivePsycl tst eval phys/qhp ea
CPT 96131 Billing & Documentation Guide
CPT code 96131 (Psycl tst eval phys/qhp ea) is classified under Psych Testing with a global period indicator of ZZZ. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.96, a non-facility practice expense RVU of 0.62, and a malpractice RVU of 0.01, a total non-facility RVU of 2.59 and facility RVU of 2.1. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $88.7, though rates vary from $83.43 to $120.44 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 96131, 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 96131 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Add-on code (global concept does not apply)
MUE Limit (Medically Unlikely Edits)
Submitting more than 7 units of 96131 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 96131
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.96 | 1.96 |
| Practice Expense RVU | 0.62 | 0.13 |
| Malpractice RVU | 0.01 | 0.01 |
| Total RVU | 2.59 | 2.1 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 96131
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 | $92.5 | $73.13 | $89.45 - $102.71 | 29 |
| Florida | $86.9 | $70.47 | $85.77 - $87.87 | 3 |
| Georgia | $85.72 | $70.1 | $84.34 - $87.1 | 2 |
| Illinois | $86.34 | $70.53 | $84.89 - $87.78 | 4 |
| Michigan | $85.38 | $70.02 | $84.75 - $86.01 | 2 |
| North Carolina | $85 | $69.73 | $85 - $85 | 1 |
| New York | $92.12 | $73.87 | $85.37 - $94.9 | 5 |
| Ohio | $84.71 | $69.77 | $84.71 - $84.71 | 1 |
| Pennsylvania | $86.7 | $70.66 | $84.79 - $88.6 | 2 |
| Texas | $86.52 | $70.41 | $84.62 - $87.8 | 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 96131
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 96131 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 96131
What does CPT code 96131 mean? +
CPT code 96131 represents: Psycl tst eval phys/qhp ea. It's in the Psych Testing category with a global period of ZZZ.
What is the Medicare reimbursement for CPT 96131? +
The 2026 Medicare national average non-facility payment for CPT 96131 is $88.7. Rates range from $83.43 to $120.44 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 96131? +
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 96131? +
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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