How much does Medicare pay for CPT 96131?

Medicare allowed an average of $82.62 per service and paid $65.50 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $154.55, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 96131?

Evaluation of psychological test, each additional hour. It was billed 60,964 times to 28,316 Medicare beneficiaries by 420 providers in 2024.

Does 96131 pay differently in an office than a hospital?

Yes. The allowed amount averaged $83.81 in an office setting and $75.88 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 96131 most?

Psychologist, Clinical, with 59,798 services from 407 clinicians. Next are Physical Medicine and Rehabilitation, Psychiatry, Family Practice.

CPT 96131

Evaluation of psychological test, each additional hour

$82.62Medicare-allowed amount per service, averaged across 60,964 services

Providers submitted

$154.55

Asking price, not received

Medicare allowed

$82.62

The fee schedule figure

Medicare paid

$65.50

Balance is patient coinsurance

Providers submitted an average of $154.55 for this code and Medicare allowed $82.62 — 1.9× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $65.50 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $83.81
Hospital / facility: $75.88

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 51,800 services were billed in an office setting and 9,165 in a facility.

Services: 60,964
Beneficiaries: 28,316
Providers billing it: 420
Total allowed: $5,036,846

What Medicare pays for CPT 96131

Across 60,964 services billed by 420 providers to 28,316 beneficiaries, Medicare allowed an average of $82.62 per service. That is 2.2 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 96131

Specialty	Services	Beneficiaries	Avg allowed	Providers
Psychologist, Clinical	59,798	27,849	$82.63	407
Physical Medicine and Rehabilitation	428	120	$81.26	1
Psychiatry	233	97	$82.96	2
Family Practice	147	46	$88.41	1
General Practice	113	73	$88.41	1
Internal Medicine	84	12	$85.80	1
Licensed Professional Counselor	55	35	$59.00	2
Cardiology	27	24	$93.28	1
Neurology	24	24	$83.14	1
Licensed Clinical Social Worker	22	13	$62.15	1
Nurse Practitioner	18	11	$69.14	1
Pain Management	15	12	$85.61	1

96131 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	24,460	$84.11	$64.39	93
Texas	9,441	$80.57	$66.55	49
Florida	4,766	$85.71	$66.38	26
Arizona	2,360	$77.71	$64.81	12
New Jersey	1,665	$79.59	$61.78	15
Nevada	1,598	$83.42	$66.81	7
Ohio	1,332	$80.55	$64.64	9
Kentucky	1,323	$81.08	$66.66	8
Massachusetts	1,223	$83.80	$66.24	8
Tennessee	1,114	$78.96	$66.50	9
Michigan	937	$81.26	$66.06	14
North Carolina	925	$82.12	$65.07	15
New York	881	$89.78	$66.09	15
Oklahoma	863	$80.65	$66.98	6
Illinois	848	$84.53	$66.45	15
Kansas	719	$80.86	$65.96	11
Colorado	675	$83.31	$66.83	6
Oregon	544	$80.87	$66.56	3
Alabama	527	$76.16	$63.29	6
Georgia	449	$79.02	$64.88	8
Indiana	391	$78.03	$64.59	8
South Dakota	381	$81.55	$66.43	4
Virginia	349	$81.34	$66.53	8
Pennsylvania	303	$84.06	$66.64	7
Utah	285	$80.50	$67.07	3
Wisconsin	282	$75.78	$65.86	4
Missouri	263	$75.03	$65.34	7
Mississippi	253	$79.31	$65.31	5
South Carolina	243	$80.40	$66.89	5
Nebraska	236	$79.45	$64.74	4
District of Columbia	220	$91.64	$67.07	1
Idaho	181	$81.50	$65.64	3
Arkansas	168	$80.70	$61.04	3
Washington	152	$82.77	$66.42	3
North Dakota	121	$80.19	$64.24	3
Connecticut	102	$87.28	$66.82	1
West Virginia	99	$80.12	$65.88	4
Minnesota	76	$76.94	$60.50	3
New Mexico	54	$85.12	$64.98	2
Alaska	36	$115.12	$67.86	1
Louisiana	34	$78.67	$64.09	2
Maryland	32	$84.93	$60.88	1
Montana	24	$84.03	$66.98	1
Rhode Island	16	$80.78	$67.96	1
Iowa	13	$70.18	$69.65	1

Related codes

96127Assessment of emotional or behavioral problems$4.47
96133Evaluation of neuropsychological test$92.52
96139Administration of psychological or neuropsychological test by technici$34.56
96137Administration of psychological or neuropsychological test$35.38
96132Evaluation of neuropsychological test$121.64
96160Administration and interpretation of patient-focused health risk asses$2.79
96138Administration of psychological or neuropsychological test by technici$33.17
96136Administration of psychological or neuropsychological test$38.12
96116Exam of neurobehavioral status$88.32
96130Evaluation of psychological test$112.99
96165Treatment of behavior impacting health in group setting$4.02
96121Exam of neurobehavioral status$71.55

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.