All PlansBilling CodesHigh impact
Billing for psychological and neuropsychological testing
Harvard Pilgrim Health Care·MA, RI · Psychiatry, Neurology·Reimbursement
We identified it
Jul 10, 2026
Summary
Point32Health clarifies billing practices for psychological and neuropsychological testing by requiring providers to bill only ONE test type per episode of care. Providers cannot bill both psychological testing codes (96130-96131) and neuropsychological testing codes (96132-96133) together; instead, they must select codes representing the predominant service. Prior authorization forms must also reflect codes from only one testing column.
Action Required
Immediately: Billing team must update all prior authorization request forms and billing workflows to enforce the rule that CPT codes 96130-96131 (psychological testing) and CPT codes 96132-96133 (neuropsychological testing) cannot be billed together in the same episode of care. Update the Tufts Health RITogether Prior Authorization Request form and any internal templates to clearly separate psychological and neuropsychological testing columns, requiring providers to check off codes from only ONE column per submission. Providers must be notified via provider bulletin that claims submitted with codes from both categories will be denied. Billing software rules must be configured to reject claims containing mixed codes. Refer providers to the updated Behavioral Health and Substance Use Disorder Payment Policy and the Medical Necessity Guidelines (MNG) on the provider website for clinical criteria and prior authorization requirements.