(Medicare Benefit Policy Manual)

Furthermore, physical therapists (PTs), occupational therapists (OTs) and speech language pathologists (SLPs) are authorized to bill three test codes as sometimes therapy codes.  Specifically, CPT codes 96105, 96110 and 96111 may be performed by these therapists.  However, when PTs, OTs and SLPs perform these three tests, they must be performed under the general supervision of a physician or a CP.  Who May Bill for Diagnostic Psychological and Neuropsychological Tests  CPs - see qualifications under chapter 15, section 160 of the Benefit Policy Manual, Pub. 100-02.   NPs -to the extent authorized under State scope of practice.  See qualifications under chapter 15, section 200 of the Benefit Policy Manual, Pub. 100-02.   CNSs - to the extent authorized under State scope of practice.  See qualifications under chapter 15, section 210 of the Benefit Policy Manual, Pub. 100- 02.   PAs -  to the extent authorized under State scope of practice.  See qualifications under chapter 15, section 190 of the Benefit Policy Manual, Pub. 100- 02.   Independently Practicing Psychologists (IPPs)    PTs, OTs and SLPs -  see qualifications under chapter 15, sections 220- 230.6 of the Benefit Policy Manual, Pub. 100- 02.  Psychological and neuropsychological tests performed by a psychologist (who is not a CP) practicing independently of an institution, agency, or physicians office are covered when a physician orders such tests.  An IPP is any psychologist who is licensed or certified to practice psychology in the State or jurisdiction where furnishing services or, if the jurisdiction does not issue licenses, if provided by any practicing psychologist.  (It is CMS understanding that all States, the District of Columbia, and Puerto Rico license psychologists, but that some trust territories do not.  Examples of psychologists, other than CPs, whose psychological and neuropsychological tests are covered under the diagnostic tests provision include, but are not limited to, educa tional psychologists and counseling psychologists.)   The A/B MAC (B) must secure from the appropriate State agency a current listing of psychologists holding the required credentials to determine whether the tests of a particular IPP are covered under Part B in States that have statutory licensure or certifi cation.  In States or territories that lack statutory licensing or certification, the A/B MAC (B) checks individual qualifications before provider numbers are issued.  Possible reference sources are the national directory of membership of the American Psychological Association, which provides data about the educational background of individuals and indicates which members are board -certified, the records and directories of the State or territorial psychological association, and the National Register of Heal th Service Providers.  If qualification is dependent on a doctoral degree from a currently accredited program, the A/B MAC (B) verifies the date of accreditation of the school involved, since such accreditation is not retroactive.  If the listed reference sources do not provide enough information (e.g., the psychologist is not a member of one of these sources), the A/B MAC (B) contacts the psychologist personally for the required information.  Generally, A/B MACs (B) maintain a continuing list of psychologi sts whose qualifications have been verified.   NOTE:   When diagnostic psychological tests are performed by a psychologist who is not practicing independently, but is on the staff of an institution, agency, or clinic, that entity bills for the psychological tests.   The A/B MAC (B) considers psychologists as practicing independently when:    They render services on their own responsibility, free of the administrative and professional control of an employer such as a physician, institution or agency;    The persons they treat are their own patients; and    They have the right to bill directly, collect and retain the fee for their services.  A psychologist practicing in an office located in an institution may be considered an independently practicing psychologist when both of the following conditions exist:    The office is confined to a separately -identified part of the facility which is used solely as the psychologists office and cannot be construed as extending throughout the entire institution; and    The psychologist conducts a private practice, i.e., services are rendered to patients from outside the institution as well as to institutional patients.   Payment for Diagnostic Psychological and Neuropsychological Tests  Expenses for diagnostic psychological and neuropsychological tests are not subject to the outpatient mental health treatment limitation, that is, the payment limitation on treatment services for mental, psychoneurotic and personality disorders as authorized under Section 1833(c) of the Act.  The payment amount for the new psychological and neuropsychological tests (CPT codes 96102, 96103, 96119 and 96120) that are billed for tests performed by a technician or a computer reflect a site of service payment dif ferential for the facility and non-facility settings.  CPs, NPs, CNSs and PAs are required by law to accept assigned payment for psychological and neuropsychological tests.  However, while IPPs are not required by law to accept assigned payment for these tests, they must report the name and address of the physician who ordered the test on the claim form when billing for tests.   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, 96110, 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 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.  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.  80.3 - Audiology Services  (Rev. 132, Issued: 09-03-10, Effective: 09-30-10, Implementation: 09 -30-10)  References .  1861(ll)(3) of the Social Security Act for the definition of audiology services.  1861(ll)(4)(B) of the Social Security Act for qualifications of audiologists.  42 CFR 410.32(b) for the physician supervision requirements for diagnostic tests.  Pub. 100-04, chapter 12, section 30.3 for coding and billing information related to audiological services and aural rehabilitation.  Pub. 100-02, chapter 15, sections 220 and 230 for the physical therapy and speech-language pathology policies relative to aural rehabilitation and balance, section 60 for services incident to a physicians service, and section 80.6 for policies relevant to ordering for diagnostic tests.  Pub. 100-02, chapter 16, section 100 for hearing aid policies.  A list of audiology services is found at: www.cms.gov/therapyservices.  A.  Benefit.   Hearing and balance assessment services are generally covered as other diagnostic tests under section 1861(s)(3) of the Social Security Act.  Hearing and balance assessment services furnished to an outpatient of a hospital are covered as diagnostic services under section 1861(s)(2)(C).  As defined in the Social Security Act, section 1861(ll)(3), the term audiology services specifically means such hearing and balance assessment services furnished by a qualified audiologist as the audiologist is legally authorized to perform under State l aw (or the State regulatory mechanism provided by State law), as would otherwise be covered if furnished by a physician.  Herein after in this section, hearing and balance assessment services are termed audiology services, regardless of whether they are furnished by an audiologist, physician, nonphysician practitioner (NPP), or hospital.  Because audiology services are diagnostic tests, when furnished by a physician in an office or hospital outpatient department, they must be furnished under the appropriate level of supervision of a physician as established in 42 CFR 410.32(b)(1) and 410.28(e).  However, as specified in 42 CFR 410.32(b)(2)(ii) or (v), respectively, they are excepted from physician supervision when they are personally furnished by a qualified audiologist or performed by a nurse practitioner or clinical nurse specialist author ized to perform the tests under applicable State laws.   Audiological diagnostic testing refers to tests of the audiological and vestibular systems, e.g., hearing, balance, auditory processing, tinnitus and diagnostic programming of certain prosthetic devices, performed by qualified audiologists.  Audiological diagnostic tests are not covered under the benefit for services incident to a physicians service (described in Pub. 100-02, chapter 15, section 60), because they have their own benefit as other diagnostic tests.  See Pub. 100-04, chapter 13 for general diagnostic test policies.   Audiology services, like all other services, should be reported under the most specific HCPCS code that describes the service that was furnished and in accordance with all CPT guidance and Medicare national and MAC instructions.  B.  Orders.   Audiology tests are covered as other diagnostic tests under section 1861(s)(3) or 1861(s)(2)(C) of the Act in the physicians office or hospital outpatient settings, respectively, when a physician (or an NPP, as applicable) orders such testing for the purpose of obtaining information necessary for the physicians diagnostic medical evaluation or to determine the appropriate medical or surgical treatment of a hearing deficit or related medical problem.  See section 80.6 of this chapter for policies regarding the ordering of diagnostic tests.   If a beneficiary undergoes diagnostic testing performed by an audiologist without a physician order, the tests are not covered even if the audiologist discovers a pathologic condition.  When a qualified physician orders a qualified technician (see definition in subsection D of this section) to furnish an appropriate audiology service, that order must specify which test is to be furnished by the technician under the direct supervision of a physician.  Only that test may be provided on that order by the technician.   When the qualified physician or NPP orders diagnostic audiology services furnished by an audiologist without naming specific tests, the audiologist may select the appropriate battery of tests.   C.  Coverage and Payment for Audiology Services.  Diagnostic services furnished by a qualified audiologist meeting the requirements in section 80.3.1 of this chapter or physicians and NPPs as described in section 80.6 are covered and payable under the MPFS as other diagnostic tests.  Services furnished in a hospital outpatient department are covered and payable under the hospital Outpatient Prospective Payment System (OPPS) or other payment methodology applicable to the provider furnishing the services.   Coverage and, therefore, payment for audiological diagnostic tests is determined by the reason the tests were performed, rather than by the diagnosis or the patients condition.  Under any Medicare payment system, payment for audiological diagnostic tests is not allowed by virtue of their exclusion from coverage in section 1862(a)(7) of the Social Security Act when:   The type and severity of the current hearing, tinnitus or balance status needed to determine the appropriate medical or surgical treatment is known to the physician before the test; or    The test was ordered for the specific purpose of fitting or modifying a hearing aid.  Payment of audiological diagnostic tests is allowed for other reasons and is not limited, for example, by:   Any information resulting from the test, for example:   Confirmation of a prior diagnosis;  Post-evaluation diagnoses; or  Treatment provided after diagnosis, including hearing aids, or   The type of evaluation or treatment the physician anticipates before the diagnostic test; or   Timing of reevaluation.  Reevaluation is appropriate at a schedule dictated by the ordering physician when the information provided by the diagnostic test is required, for example, to determine changes in hearing, to evaluate the appropriate medical or sur gical treatment or to evaluate the results of treatment.  For example, reevaluation may be appropriate, even when the evaluation was recent, in cases where the hearing loss, balance, or tinnitus may be progressive or fluctuating, the patient or caregiver complains of new symptoms, or treatment (such as medication or surgery) may have changed the patients audiological condition with or without awareness by the patient.