The American Medical Association (AMA) issued extensive changes to CPT codes used for psychological and neuropsychological testing for dates of service on and after Jan. 1, 2019. This impacts both payers and providers. The AMA modernized the coding structure to separate evaluation services from testing and administration services only. The changes will more accurately describe the work performed when multiple hours of technical and professional are required. Coding changes will impact psychiatrists and psychologists who perform psychological and neuropsychological testing services. Implementations of the new CPT codes are mandatory; non-compliance is a HIPAA violation.
Changes to CPT code sets are made annually by AMA under contract with the Centers for Medicare and Medicaid Services (CMS). The AMA has modernized the coding structure to separate evaluation services, which includes all aspects of testing, from testing and administration services only. The changes will more accurately describe the work performed when multiple hours of technical and professional services are required.
Here are the coding changes psychologists should be aware of:
- Neurobehavioral status exams are clinical interview examinations performed by a psychologist or neuropsychologist to assess thinking, reasoning, and judgment. Providers should continue to use CPT code 96116 when billing for the first hour and new code 96121 when billing for each additional hour.
- Testing evaluation services include the selection of the appropriate tests to be administered; integration of patient data; interpretation of standardized test results and clinical data; clinical decision-making; treatment planning; and reporting and interactive feedback to the patient, family members, or caregivers when performed. 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.
- Test administration and scoring by a psychologist or neuropsychologist (two or more tests using any method) should now be billed using CPT code 96136 for the first 30 minutes and 96137 for each additional 30 minutes.
- Test administration and scoring by a technician (two or more tests using any method) should now be billed using CPT code 96138 for the first 30 minutes and 96139 for each additional 30 minutes.
- Single automated test administration should be reported with newly created code 96146 for a single automated psychological or neuropsychological instrument that is administered via the electronic platform and formulates an automated result. Psychologists should not use this code if two or more electronic tests are administered and/or if the administration is performed by the professional or technician. Instead, the psychologist should use the appropriate codes listed above for test administration and scoring.
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With these testing code changes, there will be approximately a 6% increase in reimbursement rates in the CMS Physician Fee Schedule with the exception of neuropsychological batteries administered and evaluated by psychologists, for which there will be approximately a 3% reduction in reimbursement. This new payment structure unbundles services so that appropriate rates can be billed for the services of psychologists and technicians and helps to ensure that psychologists are appropriately reimbursed for their time spent on services other than face-to-face time with the client. The new structure also makes it simpler to code for testing over multiple days of service.
E2E Medical Billing Services is assisting mental health/behavioral health providers for more than 5 years and have expertise in implanting these updates to increase practice reimbursement. Need more guidance on the new CPT codes? You can call us at 888-552-1290 or write to us at info@e2eMedicalBilling.com