Neuropsychological evaluation serves as a cornerstone in mental and cognitive health, uniquely bridging the disciplines of neuroscience and psychology to unravel the intricate relationships between brain function, cognition, and behavior. Over the years, advancements in science and technology have amplified its utility, solidifying its role as an indispensable tool for both diagnosis and treatment and as a critical component of evidence-based care across a wide range of medical and psychological domains (Braun et al., 2011; Casaletto & Heaton, 2017).
Neuropsychological assessment is essential to value-based care delivery, offering diagnostic accuracy and contributing to high-quality care. However, these assessments can be time-intensive and resource-demanding, with challenges such as lengthy testing and documentation processes or extended patient wait times. Optimizing efficiency in the delivery, documentation, and billing of these assessments is crucial to overcoming these barriers, ensuring their accessibility and alignment with the principles of value-based care.
This article is designed for healthcare providers, billing specialists, and administrators who seek a comprehensive understanding of the clinical and operational facets of neuropsychological evaluations. It aims to:
By exploring these applications, this resource enables professionals to align exceptional care delivery with financial sustainability, ultimately enhancing patient outcomes and advancing healthcare quality.
A neuropsychological evaluation, commonly referred to as neuropsychological testing, is a comprehensive assessment designed to measure a wide range of cognitive abilities, behavioral functions, and neurological processes. These evaluations involve the administration, scoring, and interpretation of formal tests to assess key areas such as memory, executive functioning, attention, problem-solving, language, and visual processing.
Unlike psychological evaluations—which primarily focus on emotional, behavioral, and cognitive aspects related to mental health—neuropsychological evaluations provide a broader perspective by incorporating assessments of brain-behavior relationships and neurological functioning.
This multifaceted process plays a critical role in:
The testing process of the evaluation is grounded in evidence-based methods and relies on the use of standardized testing batteries. These batteries produce objective scores, informed by large population studies that provide “test norms” adjusted for factors such as age, education level, and cultural background.
Neuropsychological evaluations combine objective data with subjective components, such as clinical observation and qualitative analysis, to provide a comprehensive understanding of the patient’s cognitive and emotional state. The results are interpreted within a developmental and culturally sensitive framework, enabling comparisons to both the individual’s peer group and their own abilities. This dual perspective ensures diagnostically accurate and contextually meaningful insights, highlighting the patient’s cognitive strengths and challenges to guide effective care..
In accordance with APA (2024) guidance on medical necessity, neuropsychological evaluations play a vital role in determining the need for care and shaping evidence-based therapeutic strategies.
These evaluations are essential in addressing the following key areas:
Neuropsychological evaluation and testing services are critical tools for assessing and addressing cognitive, behavioral, and psychological conditions. Accurate coding not only ensures the precise representation of the provider's scope of work but also facilitates billing compliance and maximizes reimbursement, ultimately supporting the delivery of high-quality patient care.
While the terms "neuropsychological evaluation" and "neuropsychological testing" are often used interchangeably, they represent distinct components that can be categorized separately through CPT coding, as outlined in the APA's billing and coding guidelines.
CPT codes for neuropsychological services differentiate between evaluation, administration and scoring, and the roles of providers and technicians. These distinctions enable providers to accurately document and report their activities, aligning with payer requirements.
Proper utilization of these codes helps maintain compliance, optimize reimbursement, and highlight the complexity and importance of neuropsychological services in patient care.
While CPT coding guidelines generally support coverage for the evaluation of psychological conditions under CPT 96132 when both neuropsychological and psychological assessments are performed, some payers may require specific reporting based on the primary focus of the evaluation service.
For example, when assessing conditions such as anxiety or depression, which may overlap with neuropsychological assessments, payers may require the use of CPT 96130 (Psychological testing evaluation services) rather than CPT 96132 (Neuropsychological testing evaluation services). Providers should remain vigilant in reviewing payer policies to ensure compliance.
Proactive documentation and code selection help streamline reimbursement processes while ensuring compliance with payer requirements.
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For further clarification on coding distinctions and eligible providers, refer to the article: |
Understanding the limitations and requirements associated with CPT code 96132 is crucial for accurate billing and reimbursement. Coverage and restrictions often vary based on payer policies, the practitioner providing the service, and state or regional regulations. It’s always advisable to consult your insurance provider or payer guidelines for specific details relevant to your practice.
Modifiers, such as 25 or 59, should only be used when necessary and when the service meets the criteria for its use as defined by payer guidelines. Proper application of these modifiers ensures that distinct services are appropriately recognized and reimbursed while avoiding improper billing practices.
For instance, an Evaluation and Management (E/M) code (9920X–9921X) should not be used as a substitute for a neuropsychological evaluation code unless the evaluation fails to meet the required time-based or documentation standards. However, if a distinct and comprehensive E/M service is provided on the same date as the neuropsychological evaluation, the E/M service may be billed with modifier 25. This modifier is used to indicate a significant, separately identifiable service, provided proper documentation supports the distinction between the two services.
By adhering to documentation standards and using modifiers appropriately, you can streamline reimbursement processes while maintaining compliance with payer expectations.
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For additional guidance on commonly used codes in assessments, refer to Neurocognitive Billing Demystified: Differentiating CPT Codes 96125, 96116, and 96132. This resource provides valuable insights to clarify coding distinctions and ensure accurate billing practices. |
The following examples illustrate how billing and reimbursement for CPT code 96132 can vary across different healthcare workflows. These scenarios highlight the unique considerations and processes within various clinical settings, providing a clearer understanding of how this code is applied in practice.
Day 1 – Psychiatric Intake and Neuropsychological Testing
A 37-year-old male patient is referred to a clinical psychologist due to ongoing symptoms of anxiety, distractibility, interpersonal difficulties, and challenges with task organization, raising concerns for ADHD. The provider begins with a comprehensive psychiatric diagnostic evaluation (45 minutes), which confirms that the patient’s symptoms are consistent with ADHD. The evaluation includes a detailed clinical interview to assess the patient's medical history, emotional state, and behavior.
Following this, the provider uses Creyos Health’s ADHD protocol to administer neuropsychological testing (18 minutes). The provider administers the test, while also taking time (35 minutes) to review the patient's history, ensure proper testing setup, and engage in clinical decision-making.
Day 2 – Feedback Session, Post-Service Work, and Psychotherapy
The next day, the provider interprets the test results and confirms an ADHD diagnosis. Based on these findings, a customized treatment plan is developed, including medication management (15 minutes).
A feedback session is held to discuss the test results and the proposed treatment plan, completing the neuropsychological evaluation process (20 minutes). Additionally, psychotherapy (30 minutes) is provided to help the patient develop coping strategies for daily functioning. The patient is assigned follow-up tasks and scheduled for a check-in session in one month.
CPT Coding
Day 1
Day 2
Claim Submission
Since the evaluation services were provided across multiple dates, all relevant services will be submitted on a single claim. Each CPT code will be reported according to its respective date of service to ensure accurate billing and reimbursement.
Day 1 – Neurobehavioral Status Examination and Neuropsychological Testing
A 63-year-old female patient presents to a neurologist with persistent symptoms of brain fog, forgetfulness, difficulty concentrating, and challenges with task organization, raising concerns about potential cognitive impairment. The provider begins by conducting a neurobehavioral status examination (35 minutes), which confirms that the patient’s symptoms align with cognitive impairment.
Following the examination, neuropsychological testing is administered using Creyos Health’s MCI protocol (20 minutes), with a medical assistant performing the test under the provider's supervision. The provider allocates an additional 40 minutes to review the patient's medical history, ensure proper testing setup, and engage in clinical decision-making. The neurologist also orders an MRI for the patient to complete before the follow-up visit.
Day 2 – Feedback Session and Post-Service Work
During the following appointment (ideally within 1–2 weeks) the provider interprets the test results and MRI findings, confirming a diagnosis of mild cognitive impairment with early-onset Alzheimer's disease. Based on these results, a personalized treatment plan is created, including medication management (20 minutes).
A feedback session is conducted with the patient to discuss the findings and treatment plan, concluding the neuropsychological evaluation (30 minutes). The patient is given follow-up tasks to monitor progress and is scheduled for a check-in session in one month.
CPT Coding
Day 1
Day 2
Claim Submission
As the evaluation services span multiple dates, all relevant services will be submitted on a single claim, ensuring that each CPT code is reported according to its specific date of service for accurate billing and reimbursement.
Day 1 – Office Visit and Screening Services
A 24-year-old female patient presents to her physician during a routine office visit, and complains of ongoing symptoms of anxiety, distractibility, interpersonal difficulties, and challenges with task organization. She also reports frequent feelings of being overwhelmed by daily responsibilities, occasional forgetfulness, and difficulty focusing at work and in social settings. These concerns raise suspicion for possible ADHD.
The provider initiates a comprehensive screening assessment, administering the GAD-7, PHQ-9, and an ADHD Scale to evaluate the patient's emotional and cognitive state. The results confirm that the patient’s symptoms align with ADHD, as well as generalized anxiety and depressive symptoms. The provider discusses next steps with the patient, recommending a follow-up visit in one week for a full neuropsychological evaluation and testing using the Creyos Health ADHD protocol.
Day 2 – Neuropsychological Evaluation and Testing
During the second session, the provider conducts a thorough face-to-face discussion with the patient to explain the evaluation process and what she can expect from the testing, emphasizing the importance of a comprehensive understanding of her condition. The provider also takes time to review the patient's history, including lifestyle factors that may contribute to her symptoms, and ensures proper setup for the neuropsychological assessment.
Next, the medical assistant administers the neuropsychological testing (18 minutes) using Creyos Health’s ADHD protocol, under the provider’s supervision. The provider then finalizes the clinical services on this date, engaging in 40 minutes of clinical decision-making to assess the results and plan the next steps in the patient’s care.
Day 3 – Feedback Session and Post-Service Work
On the following day, the provider interprets the neuropsychological test results, confirming a diagnosis of ADHD, combined type, based on the assessment data. In light of the diagnosis, the provider creates a personalized treatment plan, including recommendations for medication management (20 minutes) and lifestyle modifications aimed at improving the patient’s focus and anxiety levels.
A feedback session is conducted with the patient to review the findings, explain the diagnosis, and discuss the treatment plan, thereby concluding the neuropsychological evaluation process (30 minutes). The provider also assigns follow-up tasks to help the patient monitor her progress and adjusts the treatment plan as necessary. A check-in session is scheduled for one month to review the patient’s response to medication and discuss any adjustments needed.
CPT Coding
Day 1
Day 2
Day 3
Claim Submission
Since the evaluation services occurred across multiple dates, the Day 1 visit will be billed on a separate claim, excluding the evaluation codes 96132, 96138 and +96133. The services provided on Day 2 and Day 3 will be bundled together on a single claim, with each CPT code reported according to the specific date of service to ensure accurate billing and reimbursement.
As CPT codes evolve, they are refined to reflect advancements in research and technology, including digital assessment platforms like Creyos Health.
Creyos Health offers a comprehensive suite of neuropsychological assessments that expand clinical capabilities while streamlining care. It also provides detailed reporting and documentation aligned with payer billing requirements, helping practices maintain compliance and efficiency. Always verify payer policies for reimbursement eligibility.
Using Creyos Health optimizes both clinical and financial performance. When billing under CPT Code 96132 (and 96133 for additional time), the following activities may be included:
Reimbursement may also apply to related test administration codes (96136, 96138, 96146) if deemed medically necessary, depending on test type, duration, personnel involvement, and payer policies. Proper documentation is essential for supporting claims and optimizing reimbursement.
Integrating Creyos Health enhances clinical outcomes, reduces administrative burden, and optimizes reimbursement—empowering providers to deliver high-quality, efficient care.
Creyos Health does not determine reimbursement eligibility and is not responsible for the outcome of any claims. The use of the provided CPT codes depends on services rendered, applicable procedures, and other factors. We recommend contacting your local payer to verify eligibility, coding, coverage guidelines, and modifier requirements.
This document is for informational purposes only and is not intended to guarantee reimbursement. Providers should consult with their payer organizations regarding local reimbursement policies. CPT®, HCPCS Level II®, and ICD-10-CM codes discussed are provided as guidelines and do not imply reimbursement approval.
Emily has 10+ years of experience in healthcare, holding CCS, CMBCS, COC, CPC, and CPMA credentials. She has trained and supported 50+ hospitals across the U.S. and internationally, focusing on compliance, optimized reimbursement, and improved coding and auditing practices.