Article - Billing and Coding: Psychological and Neuropsychological Testing (A57481)

CMS National Coverage PolicySocial Security Act 1861(s) Medical And Other Health ServicesSocial Security Act 1862(a)(7) does not extend coverage to screening procedures.42 CFR (Code of Federal Regulations):410.73 Clinical social worker services410.74 Physician assistants services410.75 Nurse practitioners services410.76 Clinical nurse specialists servicesMLN 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 Tests160 Clinical Psychological Services170 Clinical Social Worker (CSW) Services210 Clinical Nurse Specialist (CNS) ServicesCMS Publication 100-03:Medicare National Coverage Determinations (NCD)Manual, Chapter 1- Coverage Determination, Part 1, Sections 10-80:30.1 Biofeedback TherapyCMS Publication 100-04:Medicare Claims Processing Manual, Chapter 12 - Physicians/Nonphysician Practitioners:120 Nurse Practitioner (NP) and Clinical Nurse Specialist (CNS) Services Payment Methodology120.1 Limitations for Assistant-at-Surgery Services Furnished by Nurse Practitioners and Clinical Nurse Specialist150 Clinical Social Worker (CSW) Services160 Independent Psychologist Services170 Clinical Psychologist Services170.1 PaymentArticle TextThe 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 patients 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 GuidelinesReferences 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 andscoring. 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 Alzheimers diseases once a diagnosis has been made.Billing GuidelinesFor assessment of aphasia and cognitive performance testing use code 96105 and 96125, respectively.For developmental/behavioral screening and testing use codes 96110, 96112, 96113, and 96127.For neurobehavioral status examinations (includes test administration, scoring, interpretation and report) use codes 96116 and 96121.For test administration and scoring for psychological/neuropsychological testing use codes 96136, 96137, 96138 and 96139.For automated testing and results for psychological/neuropsychological testing use code 96146.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.