`96131` Psycl tst eval phys/qhp ea

What 96131 is

CMS fee schedule short descriptor: Psycl tst eval phys/qhp ea.

Full CPT long descriptions are licensed by the American Medical Association and are not published on this site; the short descriptor above is the one CMS prints in its own fee schedule file. See About CPT.

Medicare payment for 96131 (CY2026)

	Work RVU	Practice expense RVU	Malpractice RVU	Total	Medicare rate
Non-facility (office)	1.96	0.62	0.01	2.59	$86.51
Facility (hospital, ASC)	1.96	0.13	0.01	2.10	$70.14

National rates: total RVUs x the CY2026 conversion factor of 33.4009 (non-QP), before geographic adjustment. Actual Medicare payment is 80% of the rate shown after the deductible; the patient or secondary payer owes the 20% coinsurance.

Adjust for a Medicare locality:

Status: Active - payable under the Physician Fee Schedule. Global period: Add-on code: global period of the primary procedure applies.

Medically Unlikely Edit (MUE)

Medicare caps 96131 at 7 units per date of service for practitioner claims (MAI 3 - date of service edit (clinical): units above the MUE may pay with documentation on appeal), rationale: Nature of Service/Procedure. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.

Billed with 96131? These codes are bundled into it

96131 is a Column 1 code in 22 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.

Column 2 code	Short description	Modifier indicator
`0362T`	Bhv id suprt assmt ea 15 min	0 - no modifier bypass	Check pair
`0373T`	Adapt bhv tx ea 15 min	0 - no modifier bypass	Check pair
`36591`	Draw blood off venous device	0 - no modifier bypass	Check pair
`36592`	Collect blood from picc	0 - no modifier bypass	Check pair
`90785`	Psytx complex interactive	0 - no modifier bypass	Check pair
`96110`	Developmental screen w/score	1 - modifier may bypass	Check pair
`96113`	Devel tst phys/qhp ea addl	1 - modifier may bypass	Check pair
`96125`	Cognitive test by hc pro	1 - modifier may bypass	Check pair
`96127`	Brief emotional/behav assmt	0 - no modifier bypass	Check pair
`96146`	Psycl/nrpsyc tst auto result	1 - modifier may bypass	Check pair
`96160`	Pt-focused hlth risk assmt	1 - modifier may bypass	Check pair
`96161`	Caregiver health risk assmt	1 - modifier may bypass	Check pair
`96523`	Irrig drug delivery device	0 - no modifier bypass	Check pair
`97151`	Bhv id assmt by phys/qhp	0 - no modifier bypass	Check pair
`97152`	Bhv id suprt assmt by 1 tech	0 - no modifier bypass	Check pair
`97153`	Adaptive behavior tx by tech	0 - no modifier bypass	Check pair
`97154`	Grp adapt bhv tx by tech	0 - no modifier bypass	Check pair
`97155`	Adapt behavior tx phys/qhp	0 - no modifier bypass	Check pair
`97156`	Fam adapt bhv tx gdn phy/qhp	0 - no modifier bypass	Check pair
`97157`	Mult fam adapt bhv tx gdn	0 - no modifier bypass	Check pair
`97158`	Grp adapt bhv tx by phy/qhp	0 - no modifier bypass	Check pair
`G0451`	Devlopment test interpt&rep	1 - modifier may bypass	Check pair

96131 is bundled into these codes

96131 appears as a Column 2 code in 2 active edits. Reported with one of these Column 1 codes on the same date of service, 96131 is the code that denies.

Column 1 code	Short description	Modifier indicator
`96020`	Functional brain mapping	0	Check pair
`96112`	Devel tst phys/qhp 1st hr	1	Check pair

Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.