includes time spent to administer and score a minimum of two (2) neuropsychological tests. The first 30 minutes of test administration and scoring is billed using 96138 and each additional 30-minute increment needed to complete the service is billed with code 96139.
Full Answer
What is the CPT code for neuropsychological test?
Psychological and Neuropsychological Tests | CMS Psychological and Neuropsychological Tests CMS released questions and answers on psychological and neuropsychological tests that are billed under the CPT code range 96101-96125.
Is neuropsychological testing covered by Medicare?
I. COVERAGE Coverage Statement: Neuropsychological testing is covered when Medicare coverage criteria are met. Guidelines/Notes: Medicare does not have a National Coverage Determination (NCD) for neuropsychological testing.
What are the CPT codes for billing psychological testing?
It’s been almost a year since CMS rolled out new requirements for billing psychological testing services. Before there were only two CPT codes you could use: 96101 per hour with a psychologist or 96102 per hour of a technician’s time. It was the same for Neuropsychological Testing with CPT codes 96119 and 96116.
What is the CPT code for pre test evaluation?
96130: used to bill for the first hour of psychological testing evaluation services (then 96131 for each additional hour). 96116: neurobehavioral status exam, pre-test evaluation in-person by a healthcare professional; if a physician has to be with the patient during testing, this code may be most appropriate for the first hour of interaction.
Will Medicare pay for Neuropsych testing?
Coverage Guidelines Neuropsychological testing is covered when Medicare coverage criteria are met. Medicare does not have a National Coverage Determination (NCD) for neuropsychological testing.
Can 96130 be billed more than once?
How many times per year can I bill CPT 96130? 96130 may be billed as often as medically necessary. Some insurances will restrict the billing to no more than once per year.
How often can you bill 96132?
For each episode of test interpretation, CPT code 96132 would be billed for the first hour of activity (31-60 min). Any additional time associated with the test interpretation (i.e., report writing, patient feedback) would be billed using the add-on code 96133 for each additional hour.
How do you code neuropsychological testing?
Providers should now use CPT code 96130 to bill for the first hour of psychological testing evaluation services and 96131 for each additional hour. Neuropsychological evaluation services should now be billed using CPT code 96132 for the first hour and 96133 for each additional hour.
Can 96130 and 96131 be billed together?
Beyond the first hour (96130), at least an additional 31 minutes of work must be performed to bill the first unit of the add-on code 96131. Evaluation services must always be performed by the professional prior to test administration, and may be billed on the same or different days.
Is CPT 96116 covered by Medicare?
(Please note that Medicaid and Medicare plans may have additional regulation and other guidance about utilization.) 6. CPT code 96116 may be utilized by a neuropsychologist in lieu of 90791 to bill for an initial neuropsychological assessment visit, and may be utilized to bill for a 1 hour neurocognitive evaluation.
Does Medicare cover CPT 96132?
Before adjustment, the Medicare payment for CPT 96132 is $133.71 for 96132 and $101.99 per additional hour using 96133 (sources: Philips, Savonix).
Does 96132 need a modifier?
It has recently come to our attention that effective April 1, 2019, practitioners billing for CPT® codes 96138 (neurocognitive test administration) and 96132 (test interpretation, decision-making) should now use a -59 modifier on the procedure codes instead of adding a -25 modifier on the evaluation and management (E/M ...
How do I bill a Medicare cognitive assessment?
If your patient shows signs of cognitive impairment during a routine visit, Medicare covers a separate visit to more thoroughly assess your patient's cognitive function and develop a care plan – use CPT code 99483 to bill for this service.
Who can bill for 96116?
Reimbursement Requirements for CPT 96116 Neurobehavioral status exams must be completed by a physician or other qualified healthcare professional.
Who can Bill 96146?
CPT Code 96146 is used when tests are administered by a computer and is defined as “Psychological or neuropsychological test administration, with single automated instrument via electronic platform, with automated result only”.
Who can Bill 96112?
CPT 96112, developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first ...
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Social Security Act 1861 (s) Medical And Other Health Services Social Security Act 1862 (a) (7) does not extend coverage to screening procedures. 42 CFR (Code of Federal Regulations):
Article Guidance
The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the associated LCD L34646 Psychological and Neuropsychological Testing.
ICD-10-CM Codes that Support Medical Necessity
There are no ICD-10 codes listed in this Article because coverage of the service is not based on diagnosis. Providers should use the appropriate ICD-10 code.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
What is 96138 CPT code?
When a technician administers a neuropsychological assessment, separate CPT codes such as 96138 may be billed. A physician or other qualified provider may then perform the subsequent interpretation, decision making, and communication with the patient and bill using 96132.
What is CPT 96132?
A variety of qualified healthcare providers can bill for CPT 96132 after administering neuropsychological assessments. There is a high-level requirement for a clinical psychologist or a physician, such as a psychiatrist or neurologist, to supervise diagnostic tests.
How many hours can you bill for 96132?
There may be limits on the total number of hours that one provider can bill for in one day or one year for 96132 alongside other related codes for psychological and psychiatric services, although in some cases multiple services may be billed for the same date with the proper modifier code and documentation.
When does 96132 expire?
Code 96132 is set to expire as a telehealth service at the end of the year in which the COVID-19 public health emergency is declared over.
Why are CPT codes being modified?
The Centers for Medicare and Medicaid Services (CMS) announced in 2019 that CPT codes were being modified to better accommodate emerging scientific and technological advancements, which may include online assessment tools like CBS Health.
What is the code for a visit with a patient that may include CBS Health?
Additional codes for a visit with a patient that may include CBS Health: 96127: brief emotional / behavioural assessment with scoring and documentation, per standardized instrument, such as the PHQ-9 and/or GAD-7 included in CBS Health.
What is the code for cognitive testing?
Codes related to cognitive testing and evaluation often cannot be used for the same encounter when more general evaluation and management codes, such as 99308 or 99483, are also used (source: Savonix ).
What is the CPT code for psychological testing?
The range of CPT codes used to report psychological and neuropsychological tests is 96101-96120. CPT codes 96101, 96102, 96103, 96105, and 96111 are appropriate for use when billing for psychological tests. CPT codes 96116, 96118, 96119 and 96120 are appropriate for use when billing for neuropsychological tests.
What is CPT code 96101?
The technician and computer CPT codes for psychological and neuropsychological tests include practice expense, malpractice expense and professional work relative value units. Accordingly, CPT psychological test code 96101 should not be paid when billed for the same tests or services performed under psychological test codes 96102 or 96103. CPT neuropsychological test code 96118 should not be paid when billed for the same tests or services performed under neuropsychological test codes 96119 or 96120. However, CPT codes 96101 and 96118 can be paid separately on the rare occasion when billed on the same date of service for different and separate tests from 96102, 96103, 96119 and 96120.
What CPT code do psychologists use?
Before there were only two CPT codes you could use: 96101 per hour with a psychologist or 96102 per hour of a technician’s time. It was the same for Neuropsychological Testing with CPT codes 96119 and 96116.
How long does it take to get a mental health test?
For Psychological Testing Evaluation Services the math can get a bit difficult because there is a minimum 31-minute time requirement before a code “counts.”
How many minutes is a 96130 evaluation?
First Hour + the minimum 31-60 min for the next hour to “count.”. 151 – 210 minutes of evaluation – Bill one unit of 96130 and two units of 96131. 120 min + the minimum 31 min to count as an hour.
Who can do testing evaluation?
Test Evaluation Services – which can only be done by a psychologist or other qualified healthcare professional. Test Administration and Scoring – which can be done by a psychologist (or similar) or a Technician. When it comes to billing, it’s easiest to break these down into roles and minutes.
Psych Testing Reimbursement Rates 2022
Please see our table below for reimbursement rate data per CPT code in 2022, 2021, and 2020.
Psychological and Neuropsychological Services Coding Guidelines
Each psych testing CPT code is different. Maker sure to review current Medicare service provider guidelines to ensure you’re exceeding expectations on behalf of yourself and your clients.