CPT 96133
Global ZZZ ActiveNrpsyc tst eval phys/qhp ea
CPT 96133 Billing & Documentation Guide
CPT code 96133 (Nrpsyc 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 0.95, and a malpractice RVU of 0.02, a total non-facility RVU of 2.93 and facility RVU of 2.11. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $100.49, though rates vary from $93.07 to $132.36 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 96133, 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 96133 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 96133 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 96133
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.96 | 1.96 |
| Practice Expense RVU | 0.95 | 0.13 |
| Malpractice RVU | 0.02 | 0.02 |
| Total RVU | 2.93 | 2.11 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 96133
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 | $105.72 | $73.31 | $101.71 - $118.78 | 29 |
| Florida | $98.6 | $71.12 | $96.8 - $100.19 | 3 |
| Georgia | $96.63 | $70.51 | $94.57 - $98.7 | 2 |
| Illinois | $97.63 | $71.17 | $95.48 - $99.7 | 4 |
| Michigan | $96.2 | $70.48 | $95.19 - $97.21 | 2 |
| North Carolina | $95.5 | $69.94 | $95.5 - $95.5 | 1 |
| New York | $104.88 | $74.32 | $96.08 - $108.62 | 5 |
| Ohio | $95.11 | $70.1 | $95.11 - $95.11 | 1 |
| Pennsylvania | $97.85 | $71.02 | $95.23 - $100.47 | 2 |
| Texas | $97.68 | $70.72 | $94.96 - $99.76 | 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 96133
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 96133 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 96133
What does CPT code 96133 mean? +
CPT code 96133 represents: Nrpsyc 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 96133? +
The 2026 Medicare national average non-facility payment for CPT 96133 is $100.49. Rates range from $93.07 to $132.36 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 96133? +
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 96133? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team