CPT
90471 — Immunization administration, single vaccine
ACA-covered vaccines should be free, including the admin fee.
Mental health
96130 — Psychological testing evaluation services; first hour
This code covers the first hour of a psychologist's or qualified professional's work in reviewing, integrating, and interpreting psychological test results, developing treatment recommendations, and writing the formal...
- Typical setting: Therapist's office, hospital, telehealth
- National avg charge (illustrative): $100–$250 (Medicare non-facility rate approximately $125 in 2026)
- Most-disputed reason: Billing 96130 without corresponding test administration codes (96136 or 96138) when testing was also performed — the evaluation and administration are separate billable components.
What it means
What 96130 actually means
This code covers the first hour of a psychologist's or qualified professional's work in reviewing, integrating, and interpreting psychological test results, developing treatment recommendations, and writing the formal report. It requires at least 31 minutes of this professional evaluation work.
Common errors with this code
What goes wrong on real bills.
Most bills that look correct still contain at least one of these issues. Up to 49% of medical bills contain errors (CFPB).
- Billing 96130 without corresponding test administration codes (96136 or 96138) when testing was also performed — the evaluation and administration are separate billable components.
- Billing both 96127 (brief screening) and 96130/96136 on the same date of service — these code families cannot be combined on the same day.
- Inadequate time documentation — this is a time-based code requiring documented total time spent in evaluation activities; claims without time records are routinely denied.
If you see 96130 on your bill
Three steps before paying.
1. Get the itemized bill. If your statement only shows a summary, request the CPT-level itemized bill before paying. Generate the request language →
2. Cross-check against the EOB. Compare what your insurer's Explanation of Benefits says you owe versus what the hospital is asking. They disagree more often than people think. Read the bill-vs-EOB guide →
3. Run a free Bill Scan. Upload the bill (and EOB if you have it) and BillBusted will flag the most likely issues with this specific code in your specific state. Run free scan →
Related codes
Other codes in this category.
People who land on 96130 often also see these adjacent codes on the same bill.
CPT
90472 — Immunization admin; each additional vaccine
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90651 — Human papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90670 — Pneumococcal conjugate vaccine, 13 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90671 — Pneumococcal conjugate vaccine, 15 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90677 — Pneumococcal conjugate vaccine, 20 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
Related BillBusted guides
Plain-English reads if you see 96130 on a bill.
96130 FAQ
Plain-English answers.
What does 96130 usually cost?
$100–$250 (Medicare non-facility rate approximately $125 in 2026). Costs vary by region, payer contract, and whether the service was performed in a hospital outpatient department (which adds a facility fee) versus a free-standing clinic.
What's the most common billing error on 96130?
Billing 96130 without corresponding test administration codes (96136 or 96138) when testing was also performed — the evaluation and administration are separate billable components.
What should I do if I see 96130 on my bill?
Request the itemized bill and the matching EOB from your insurer. Compare the units/quantity billed against what you actually received. Run a free BillBusted scan to flag the most likely errors specific to 96130 before paying.
Don't pay 96130 blindly.
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