Local Coverage Article Billing and Coding

Billing and Coding: Psychological and Neuropsychological Testing

A57481

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Contractor Information

Article Information

General Information

Article ID
A57481
Article Title
Billing and Coding: Psychological and Neuropsychological Testing
Article Type
Billing and Coding
Original Effective Date
10/31/2019
Revision Effective Date
09/29/2022
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2021 American Dental Association. All rights reserved.

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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):

410.73 Clinical social worker services
410.74 Physician assistants’ services
410.75 Nurse practitioners’ services
410.76 Clinical nurse specialists’ services

MLN Matters Number SE0441 “Incident to” Services.

CMS Publication 100-02: Medicare Benefit Policy Manual, Chapter 15 - Covered Medical and Other Health Services:

§80.2 Psychological and Neuropsychological Tests
§160 Clinical Psychological Services
§170 Clinical Social Worker (CSW) Services
§210 Clinical Nurse Specialist (CNS) Services

CMS Publication 100-03: Medicare National Coverage Determinations (NCD)Manual, Chapter 1- Coverage Determination, Part 1, Sections 10-80:

§30.1 Biofeedback Therapy

CMS Publication 100-04: Medicare Claims Processing Manual, Chapter 12 - Physicians/Nonphysician Practitioners:

§120 Nurse Practitioner (NP) and Clinical Nurse Specialist (CNS) Services Payment Methodology
§120.1 Limitations for Assistant-at-Surgery Services Furnished by Nurse Practitioners and Clinical Nurse Specialist
§150 Clinical Social Worker (CSW) Services
§160 Independent Psychologist Services
§170 Clinical Psychologist Services
§170.1 Payment

Article Guidance

Article Text

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.

Psychological and Neuropsychological Testing are diagnostic procedures that must be used as an important tool in making specific diagnoses or prognoses to aid in treatment planning and to address questions regarding treatment goals, efficacy, and patient disposition. Diagnostic procedures that have no impact on a patient’s plan of care or have no effect on treatment are not medically necessary. The CPT Codes discussed in this Billing and Coding Article are used to report the services provided during testing of the cognitive function of the central nervous system. The testing of cognitive processes, visual motor responses and abstractive abilities is accomplished by the combination of several types of testing procedures.

Coding Guidelines
References to providers throughout this policy include non-physicians, such as clinical psychologists, independent psychologist, nurse practitioners, clinical nurse specialists and physician assistants when the services performed are within the scope of their clinical practice/education, licensed and authorized under the state law.

A minimum of 31 minutes must be provided to report any per hour code.

Psychological or neuropsychological testing includes selection, administration and scoring of the tests, directly by the psychologist, neuropsychologist, physician or other qualified health care professional, by a technician under the clinician's direct supervision, by computerized test administration, or via some combination of these three approaches.

Typically, testing requires 4-8 hours to perform, including administration and scoring. If the testing is performed over several days, the time for all testing should be combined and reported on the last day of service.

Psychological and Neuropsychological testing is medically necessary for multiple reasons. The medical record must document the reason the tests are being performed. The LCD does not define coverage for either the medical or psychiatric diagnosis that may require the services.

Psychological and neuropsychological testing is not covered for Alzheimer’s diseases once a diagnosis has been made.

Billing Guidelines

  1. For assessment of aphasia and cognitive performance testing use code 96105 and 96125, respectively.
  2. For developmental/behavioral screening and testing use codes 96110, 96112, 96113, and 96127.
  3. For neurobehavioral status examinations (includes test administration, scoring, interpretation and report) use codes 96116 and 96121.
  4. For test administration and scoring for psychological/neuropsychological testing use codes 96136, 96137, 96138 and 96139.
  5. For automated testing and results for psychological/neuropsychological testing use code 96146.
  6. To bill these services to Medicare the practitioner providing the testing must have a Medicare provider number and be appropriately licensed in the State where the services are performed.

Coding Information

CPT/HCPCS Codes

Group 1

(12 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
96105 Assessment of aphasia
96112 Devel tst phys/qhp 1st hr
96113 Devel tst phys/qhp ea addl
96116 Nubhvl xm phys/qhp 1st hr
96121 Nubhvl xm phy/qhp ea addl hr
96125 Cognitive test by hc pro
96127 Brief emotional/behav assmt
96136 Psycl/nrpsyc tst phy/qhp 1st
96137 Psycl/nrpsyc tst phy/qhp ea
96138 Psycl/nrpsyc tech 1st
96139 Psycl/nrpsyc tst tech ea
96146 Psycl/nrpsyc tst auto result

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 1 Paragraph

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.

Group 1 Codes

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

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ICD-10-PCS Codes

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Additional ICD-10 Information

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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. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

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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. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
09/29/2022 R3

Posted 09/29/2022 Review completed 09/02/2022 with no changes in coverage.

10/01/2020 R2

10/01/2020 Removed outdated language in CMS National Coverage Policy section. Under Coding Guidelines: removed coding guidelines for psychological/neuropsychological testing evaluation since it is a separate service from psychological/neuropsychological test administration and scoring. Under CPT/HCPCS Codes, Group 1 Codes: removed 96130, 96131, 96132 and 96133. Review completed 8/15/2020.

01/01/2020 R1

12/26/2019 CPT/HCPCS annual update: CPT/HCPCS Codes Group 1: long description change to 96125. Minor formatting changes.

Associated Documents

Related Local Coverage Documents
LCDs
L34646 - Psychological and Neuropsychological Testing
Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
09/21/2022 09/29/2022 - N/A Currently in Effect You are here
09/22/2020 10/01/2020 - 09/28/2022 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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