CPT CODE 96116, 96118, 96119, 96120 -Neuropsychological testing

CPT CODE and Description

96116 - Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), per hour of the psychologist's or physician's time, both face-to-face time with the patient and time interpreting test results and preparing the report - Average fee amount - $75 - $110

96118 - Neuropsychological testing (eg, Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), per hour of the psychologist's or physician's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report

96119 - Neuropsychological testing (eg, Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), with qualified health care professional interpretation and report,

96120 - Neuropsychological testing (eg, Wisconsin Card Sorting Test), administered by a computer, with qualified health care professional interpretation and report


96116 Explained 

• “A neurobehavioral status exam is completed prior to the administration of neuropsychological testing. The status exam involves clinical assessment of the patient, collateral interviews (as appropriate and review of prior records. The interview would involved clinical assessment of several domains including but limited to; thinking, reasoning and judgment, e.g., acquired knowledge, attention, language, memory, planning and problem solving and visual spatial abilities. The clinical assessment would determine the types of tests and how those tests should be administered.”

Billing on the same day as an office visit: What Modifiers?

Modifiers 25, 59 and 52 are the most common modifiers used. The use and need of modifiers may vary so consultation with payers and carriers for definitive guidance on their policies is recommended. Carriers may determined that when psychological, neuropsychological or developmental testing and/or clinical and quality rating instrument coding is reported in conjunction with an assessment code e.g., 90791-90792 psychiatric evaluation exam, 96116 for neurobehavioral status exam or an E&M code, the time and effort to perform the testing itself is not counted toward the key components (history, physical exam and medical decisionmaking). Coding for the testing administration / interpretation and/or its integration into the overall patient evaluation are viewed by some payers as two separate and distinct services that are both above and beyond the office visit.

Medicare’s estimated reimbursement of the procedure codes, 96118-19, 96101-02 are based on 1 hr of testing. How should the time period spent in testing, interpreting and reporting the test results be factored into the billing?

The time component is not defined or addressed by Medicare so billing should be done in 1 hour increments. If testing, interpreting results, reporting, takes more than one-half hour, then one unit of the appropriate code should be billed. If testing, interpreting results, reporting takes more than one and one-half hour, then two units of the procedure code should be billed.

While the MCI Screen and Depression Screen are easily administered within minutes, the effort required to prepare for the patient’s visit and to counsel the patient should also be considered. Such considerations could include but are not limited to Physician time spent:

• Pulling a patient’s record (E&M)

• Familiarizing themselves with the clinical decision making process that led them to be tested (E&M)

• Meeting with the patient to remind them of the reason for the test and prepare them to be tested (E&M)

• Reviewing the results of the assessment, analyzing and interpreting the report (E&M)

• Developing a plan of care (Interpretation)

• Meeting with the patient, discussing the results and recommending a plan of care (E&M)


CPT Codes for Diagnostic Psychological and Neuropsychological Tests

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.

All of the tests under this CPT code range 96101-96120 are indicated as active codes under the physician fee schedule database and are covered if medically necessary.



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. Services 96101, 96116, 96118 and 96125 report time as (a) face–to-face with the patent and (b) time spent interpreting and preparing the report.

Typically, the neuropsychological evaluation requires 4-8 hours to perform, including administration, scoring, interpretation, report writing and interpretation to the patient and/or family. If the evaluation is performed over several days, the time should be combined and reported all on the last day of service .


CPT code equivalents of the most common components of the neuropsychological assessment include:

1. Direct clinical observation and interview with the patient, often with caregivers or significant others who serve as sources of information that the patient may be unable to provide (e.g., spouse, parent, adult child, care staff, therapists),
96116;

2. Review of medical records and, in some cases, other relevant records (e.g., work history, educational history, criminal or social services records, etc.), 96118;


Q: Can I perform psychological testing and psychotherapy on the same date of service?

A: No, the following therapy codes will be considered not separately reimbursed if provided on the same date of service as 96101, 96102, 96116, 96118, or 96119: 90804, 90805, 90806, 90807, 90808, 90809, 90810, 90811, 90812, 90813, 90814, 90815, 90823, 90824, 90826, 90827.

Reimbursement changes for CPT code 96116

Clinical evaluation of thinking and other mental functions is ingrained into every day medical practice. Assessment can be as simple as recognition by the practitioner that a long-standing patient seems unable to report details and grasp  the significance of a clinical situation or as complicated as an extensive battery of tests to sort out complex deficits. Several central nervous system assessment codes describe a middle ground. The examination is more detailed than a comprehensive evaluation and management examination, but less systematic and thorough than a comprehensive battery of
psychological or neuropsychological testing. Practices depend on the proper use of Current Procedural Terminology (CPT).

One of these codes is 96116- neurobehavioral status exam. It is defined in the CPT manual as ‘neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), per hour of the psychologist’s or physician’s time, both face to face time with the member and time interpreting test results and preparing the report.’

We are implementing a new reimbursement policy that follows the CPT guidance restricting billable use of this code to psychologists and/or physicians. In addition, there will be a limit of 5 hours/units per year, to help ensure the code is being used consistently. Instances of services exceeding 5 hours/units per year are subject to review for case-specific detail This  February 2014 Connecticut 14 of 20 policy applies to all commercial Anthem health plans. (Please note that Medicaid and Medicare plans may have additional regulation and other guidance about utilization.)


96116 Testing &  Interpretation Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, e.g., acquired knowledge, attention, language, memory, planning and problem Striving, and visual spatial abilities), per hour of the psychologist's or physician's time, both face-to-face time with the patient and time interpreting test results and preparing the report. $93

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.

7. A psychologist who bills for services delivered by a psychometrist, psychometrician or CPA should use CPT code 96102 (for psychological testing) or 96119 (for neuropsychological testing).

8. A psychologist who bills for testing administered by computer should use CPT Code 96103 (psychological testing) or 96120 (for neuropsychological testing).

9. The Wada hemispheric activation test (CPT code 95958) is an open brain pre-surgical procedure when neuropsychological tests are administered along with EEG monitoring to determine the hemisphere of the brain responsible for cognitive functions such as speed and memory. The neuropsychological testing component is sometimes billed using the 65958 CPT code or may be billed using the 96118 neuropsychological testing CPT code. The neuropsychological testing component of the Wada test may be covered as a medical benefit.

96020 – Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered by a psychologist or physician, with review of test results and report. Note that CPT code 96020 should not be used in conjunction with 96101-96103, 96116, or 96120.


Neurobehavioral Status Exam

96116 – Neurobehavioral Status Exam: Clinical assessment of thinking, reasoning and judgment (e.g., acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), per hour of psychologist's or physician's time, both
8 face-to-face time with the patient and time interpreting test results and preparing the report.


What modifiers are valid when billed with Healthcare Common Procedure Coding System (HCPCS) code 96116?

Effective January 1, 2008, the following modifiers are valid when billed with HCPCS code 96116:

• GT – Via interactive audio and video telecommunications system


ICD9 CODES*

437.9 (Cerebrovascular insufficiency)

780.93 (Memory loss)

294.8 (Dementia)

331.0 (Alzheimer's disease)

The ICD-9 codes above are listed as an example. The final determination of the ICD-9 code(s) must be the physician’s responsibility.

Some Medicare carriers have adopted Local Coverage Determination(s) (LCDs) which include a very specific list of ICD-9 Diagnosis Codes to be used for Psychiatry and Psychological services which include CPT Codes 96118, 96119. It is suggested that you check to see if your specific carrier has adopted such a policy before billing for these procedures.


CPT Codes for Diagnostic Psychological and Neuropsychological Tests

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.

All of the tests under this CPT code range 96101-96120 are indicated as active codes under the physician fee schedule database and are covered if medically necessary.

Payment and Billing Guidelines for Psychological and Neuropsychological Tests 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  europsychological test code 96118 should not be paid when billed for the same tests or services performed  nder 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.

Under the physician fee schedule, there is no payment for services performed by students or trainees. Accordingly, Medicare does not pay for services represented by CPT codes 96102 and 96119 when performed by a student or a trainee. However, the presence of a student or a trainee while the test is being administered does not prevent a physician, CP, IPP, NP, CNS
or PA from performing and being paid for the psychological test under 96102 or the neuropsychological test under 96119.http://www.cms.gov/manuals/Downloads/bp102c15.pdf Text:

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 LCD and Billing and Coding Guidelines 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. Services 96101, 96116, 96118 and 96125 report time as (a) face–to-face with the patent and (b) time spent interpreting and preparing the report.

Typically, the neuropsychological evaluation requires 4-8 hours to perform, including administration, scoring, interpretation, report writing and interpretation to the patient and/or family. If the evaluation is performed over several days, the time should be combined and reported all on the last day of service CPT code equivalents of the most common components of the neuropsychological assessment include:

1. Direct clinical observation and interview with the patient, often with caregivers or significant others who serve as sources of information that the patient may be unable to provide (e.g., spouse, parent, adult child, care staff, therapists),  6116;

2  Review of medical records and, in some cases, other relevant records (e.g., work history, educational history, criminal or social services records, etc.), 96118;
3. Completion of forms and questionnaires by the patient and significant others (not
billable);

4. Selection, administration and interpretation of neuropsychological tests, directly by the neuropsychologist (96118); or by a technician under the neuropsychologist's direct supervision (96119), or by computerized test administration (96120), or via some combination of these three approaches to test administration;


5. Integration of neuropsychological test findings, across tests, and with information from history, observation, questionnaire, and interview, by the neuropsychologist (96118);

6. Formulation of the differential diagnoses, diagnostic conclusions, prognosis, and treatment recommendations, by the neuropsychologist (96118);

7. Provision of a feedback or treatment planning conference to the patient, with significant others as needed, to explain the test procedures, results, implications, conclusions, recommendations, and follow-through as needed (96118);

8. Preparation and provision of a written report to the patient and referring health care provider, and to other treatment providers with written informed consent to release information signed by the patient (96118).

CPT code 96119 is reported for tests administration by a technician who is hired, trained, and directly supervised by a practitioner licensed by the State to provide neuropsychological testing:

During testing, the qualified health professional frequently checks with the technician to monitor the patient’s performance and make any necessary modifications to the test battery or assessment plan. When all tests have been administered, the qualified health professional meets with the patient again to answer any questions (AMA CPT Assistant, November 2006). The time spent reviewing the results of these tests and writing the report is also reported using the same CPT code 96119.

Code 96120 is reported for computer-administered neuropsychological testing, with subsequent interpretation and report of the specific tests by the physician, psychologist, or other qualified health care professional.


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