Coding tip for psychological and neuropsychological testing
A change to CPT® codes for psychological and neuropsychological test administration and evaluation services for Anthem HealthKeepers Plus members was effective January 1, 2019.* The new codes do not crosswalk on a one-to-one basis with the deleted codes.
These coding changes separate test administration from test evaluation, psychological testing evaluation from neuropsychological testing evaluation and define the testing performed by a professional or technician. The information below clarifies coding for these services.
Please note: Prior authorization (PA) requirements have not changed. Please check the Precertification Look Up Tool for PA requirements for each code.
Neurobehavioral status exams
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.
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.
Testing evaluation services
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). There are distinct testing evaluation service codes for psychological testing and for neuropsychological testing.
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.
Single automated test administration
Single automated test administration should be reported with newly created code 96146 for a single automated psychological or neuropsychological instrument that is administered via electronic platform and formulates an automated result. Psychologists should not use this code if two or more electronic tests are administered and/or if administration is performed by the professional or technician. Instead, the psychologist should use the appropriate codes listed above for test administration and scoring. A single automated test as the only service is not considered appropriate for the many elements seen with test evaluation.
Screening and risk assessment (repetitive assessment after screening)
Screening and risk assessment (repetitive assessment after screening) includes brief emotional/behavioral assessment (for example, a depression inventory or ADHD scale) with scoring and documentation, per standardized instrument. This should be billed using CPT code 96127 separately from testing. Brief emotional/behavioral assessments should not be billed as psychological or neuropsychological testing.
If you have any questions about this communication, call Provider Services at 1‑800‑901‑0020 or Anthem CCC Plus Provider Services at 1‑855‑323‑4687.
* American Psychological Association website: 2019 Psychological and Neuropsychological Testing Billing and Coding Guide: https://www.apa.org
March 2020 Anthem Provider News - Virginia