CPT Code 96137Complete Billing & Coding Guide (2026)Psycl/nrpsyc tst phy/qhp ea
About CPT 96137
CPT 96137 is a Current Procedural Terminology code in the Psych Testing category maintained by the American Medical Association. The CMS short descriptor reads "Psycl/nrpsyc tst phy/qhp ea". For the full AMA long descriptor and clinical guidance, refer to the current CPT code manual.
Add-on codes cannot be billed alone and inherit their global period from the primary procedure. Payer scrubbers will reject add-on codes submitted without a valid base code on the same claim.
96137 has 10 NCCI bundling edit pairs documented. Run your scrubber against the NCCI quarterly update before submission. When clinically warranted, use modifier 59 or the X-modifiers (XE, XS, XP, XU) to bypass an indicator-1 edit, with chart documentation supporting the distinct service.
Code Properties
RVU Breakdown
Every CPT code’s Medicare payment is calculated from three Relative Value Unit components: physician work, practice expense, and malpractice. Together they multiply by the conversion factor to produce the payment amount.
Payment = Total RVU × Conversion Factor ($33.4009) × Geographic Adjustment (GPCI). National averages shown. Actual payment varies by locality.
Medicare Payment by State
Medicare adjusts payment by locality based on GPCI (Geographic Practice Cost Index). Higher cost-of-living areas like California and New York pay more. Rural states pay less. Top 12 states shown.
Showing top 12 of 53 states. Full locality data available in CMS PFS Locality file.
NCCI Bundling Edits
10 pairsThese codes trigger National Correct Coding Initiative edits when billed with 96137. An indicator of 0 means the pair cannot be unbundled. Indicator 1 means modifier 59 or X-modifiers may allow separate billing with supporting documentation.
96137 + 0362T: hard bundle (indicator 0)
The most-asked bundling question on this code. Verdict pulled from the current NCCI quarterly file.
Modifier indicator 0 means this edit cannot be bypassed. Do not append modifier 59 or X-modifiers. The bundled code must be written off, or, if clinically inappropriate, the entire claim reconsidered.
CPT Manual or CMS manual coding instruction
Billing 96137 alongside a bundled code without the correct modifier generates CARC 97 denials. Payers often flag these as audit risks. Document medical necessity for the separate service and apply modifier 59 or the appropriate X-modifier (XE, XS, XP, XU) only when clinically justified.
CPT Manual or CMS manual coding instruction
CPT Manual or CMS manual coding instruction
CPT Manual or CMS manual coding instruction
CPT Manual or CMS manual coding instruction
CPT Manual or CMS manual coding instruction
Mutually exclusive procedures
Mutually exclusive procedures
CPT Manual or CMS manual coding instruction
Misuse of Column Two code with Column One code
Mutually exclusive procedures
Bundling denials on 96137 are recoverable when the edit indicator is 1 and the chart documents a distinct, separately identifiable service. Our coders verify the indicator and pick the precise X-modifier (XE, XS, XP, XU) instead of defaulting to modifier 59.
Got a CO-97 on 96137 and 0362T? Send us the EOB before you write it off.
Indicator 0 means no modifier bypasses the edit. A real coder should confirm before the charge is written off. Some look-alike edits get appealed successfully on documentation grounds.
Remove patient name, DOB, and member ID before pasting.
Applicable Modifiers
Modifiers commonly paired with 96137 based on its category. Apply only when the clinical circumstance warrants. Incorrect modifier use is a top audit target.
Modifier audits catch what scrubbers miss. Our AAPC-certified team reviews every modifier choice on 96137 against the chart documentation before submission, surfacing missed and misapplied modifiers across the practice.
Supporting ICD-10 Diagnoses
These diagnosis codes commonly support medical necessity for CPT 96137. Using the correct ICD-10 prevents CARC 50 denials. Payer rejects when the diagnosis doesn’t support the procedure.
CARC 50 medical-necessity denials carry both rework cost and an audit-risk signal when patterns repeat. Our coders verify ICD-10 specificity and policy alignment at the coding stage so these losses get prevented upstream.
Find the revenue leakage in your 96137 claims.
Wrong modifier, missing documentation, bundling without justification, stale ICD-10 linkage: these are the silent revenue killers on Psych Testing claims. Our AAPC-certified team audits your last 90 days of 96137 claims, surfaces the recoverable dollars, and appeals them. Free, no obligation.
Losing revenue on CPT 96137? We’ll find it.
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Related CPT Codes
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Specialty billing guides
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Everything about CPT 96137
What does CPT code 96137 cover?
CPT 96137 is a Current Procedural Terminology code in the Psych Testing category maintained by the American Medical Association. The CMS short descriptor reads "Psycl/nrpsyc tst phy/qhp ea". For the full AMA long descriptor and clinical guidance, refer to the current CPT code manual.
What is the Medicare payment for CPT 96137?
The national average Medicare payment for CPT 96137 is approximately $37.07 in a non-facility setting and $16.37 in a facility setting. Actual payment varies by locality based on GPCI adjustments. Total RVU is 1.11 with a conversion factor of $33.4009.
What is the global period for CPT 96137?
CPT 96137 is an add-on code (indicator ZZZ). Its global period matches the base procedure it's billed with. Cannot be billed alone. Must be paired with a primary code per CPT guidelines.
What codes bundle with CPT 96137?
CPT 96137 has NCCI Procedure-to-Procedure edits with 10+ codes including 0362T, 0373T, 36591. Modifier indicator 0 means the edit cannot be bypassed. Indicator 1 means modifier 59 or X-modifiers may allow separate billing with documentation.
CPT codes and descriptions are copyright of the American Medical Association. RVU values reflect current CMS publications. Actual payment varies by locality. Commercial payer rates vary by contract.
Free 90-Day AR Recovery Audit
We audit your last 90 days of claims and surface the revenue leakage: wrong modifiers, missed bundling appeals, ICD-10 specificity gaps. AAPC-certified coders. 2.49% of collections. No setup fees.