CPT 96136
Global XXX ActivePsycl/nrpsyc tst phy/qhp 1st
CPT 96136 Billing & Documentation Guide
CPT code 96136 (Psycl/nrpsyc tst phy/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 0.55, a non-facility practice expense RVU of 0.74, and a malpractice RVU of 0.02, a total non-facility RVU of 1.31 and facility RVU of 0.64. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $45.11, though rates vary from $39.95 to $56.39 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 96136, 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 96136 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 96136 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 96136
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.55 | 0.55 |
| Practice Expense RVU | 0.74 | 0.07 |
| Malpractice RVU | 0.02 | 0.02 |
| Total RVU | 1.31 | 0.64 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 96136
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 | $48.64 | $22.16 | $46.13 - $56.39 | 29 |
| Florida | $44.47 | $22.02 | $43 - $45.79 | 3 |
| Georgia | $42.78 | $21.43 | $41.21 - $44.34 | 2 |
| Illinois | $43.6 | $21.97 | $41.98 - $45.07 | 4 |
| Michigan | $42.52 | $21.51 | $41.69 - $43.35 | 2 |
| North Carolina | $41.86 | $20.98 | $41.86 - $41.86 | 1 |
| New York | $47.72 | $22.76 | $42.32 - $50.17 | 5 |
| Ohio | $41.61 | $21.18 | $41.61 - $41.61 | 1 |
| Pennsylvania | $43.46 | $21.54 | $41.69 - $45.23 | 2 |
| Texas | $43.43 | $21.39 | $41.48 - $45.15 | 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 96136
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 96136 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 96136
What does CPT code 96136 mean? +
CPT code 96136 represents: Psycl/nrpsyc tst phy/qhp 1st. It's in the Psych Testing category with a global period of XXX.
What is the Medicare reimbursement for CPT 96136? +
The 2026 Medicare national average non-facility payment for CPT 96136 is $45.11. Rates range from $39.95 to $56.39 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 96136? +
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 96136? +
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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