Psychiatry & psychotherapy

96130 - RVUs & Medicare payment (2026)

Psychological test evaluation, first hour.

Component	Non-facility	Facility
Work RVU	2.56	2.56
Practice expense RVU	1.06	0.33
Malpractice RVU	0.09	0.09
Total RVUs	3.71	2.98
National payment (CF $33.4009)	$123.92	$99.53
Qualifying APM payment (CF $33.5675)	$124.54	$100.03

How 96130 payment varies by locality

Medicare adjusts payment with geographic practice cost indices, so the same code pays differently across the 109 fee schedule localities. In 2026, non-facility payment for 96130 ranges from $117.47 in Arkansas (AR) to $167.62 in Alaska (AK); calculate 96130 for your locality.

Alaska (AK) $167.62 San Jose-Sunnyvale-Santa Clara (CA) $147.58 San Jose-Sunnyvale-Santa Clara (CA) $147.16 San Francisco-Oakland-Berkeley (CA) $144.93 San Francisco-Oakland-Berkeley (CA) $144.83 Napa (CA) $139.08 Vallejo (CA) $138.94 NYC Suburbs/Long Island (NY) $138.66 National average $123.92 … 97 more localities between … Rest Of Missouri (MO) $118.95 Mississippi (MS) $118.21 Alabama (AL) $118.19 Arkansas (AR) $117.47

Non-facility payment for 96130 in the 2026 fee schedule ($33.4009 conversion factor), before sequestration. Gray bar = national average.

Global period: XXX

No global period: the global surgery concept does not apply to this code.

Related codes - psychiatry & psychotherapy

90791 · psychiatric diagnostic evaluation, no medical services
90792 · psychiatric diagnostic evaluation with medical services
90832 · psychotherapy, 30 minutes
90833 · psychotherapy 30 minutes, add-on to an e/m visit
90834 · psychotherapy, 45 minutes
90836 · psychotherapy 45 minutes, add-on to an e/m visit
90837 · psychotherapy, 60 minutes
90838 · psychotherapy 60 minutes, add-on to an e/m visit
90839 · psychotherapy for crisis, first 60 minutes
90846 · family psychotherapy without the patient present, 50 minutes
90847 · family psychotherapy with the patient present, 50 minutes
90853 · group psychotherapy
96131 · psychological test evaluation, each additional hour
96136 · psychological/neuropsychological test administration, first 30 minutes
96156 · health behavior assessment or re-assessment
96158 · health behavior intervention, individual, first 30 minutes

Frequently asked questions

How much does Medicare pay for 96130 in 2026?

The national non-facility payment is $123.92 and the facility payment is $99.53, using the standard $33.4009 conversion factor. Actual amounts vary by Medicare locality; use the RVU calculator for your area.

What is the work RVU for 96130?

The 2026 work RVU for 96130 is 2.56. Total RVUs are 3.71 in the non-facility setting and 2.98 in the facility setting.

Why are the facility and non-facility amounts different?

Only the practice expense component changes by setting. In an office (non-facility) the practice bears the overhead, so the PE RVU is higher; in a hospital or ASC the facility bills its own overhead separately.

Source: CMS Physician Fee Schedule relative value file (rvu26c.zip, retrieved 2026-07-11). Service description is an original plain-English summary, not CPT descriptor text. CPT® is a registered trademark of the American Medical Association. Amounts are estimates before sequestration and claim-level adjustments.