Please note that Creyos Health can not determine your eligibility for reimbursement and does not assume responsibility over the outcome of any claims. Use of the following CPT codes will depend on services provided, procedures, associated CCI edits, and other factors.
Please contact your local payer to determine whether you qualify for the codes we outline below, as well as for any additional coding and coverage guidelines, services, limits on billable time, and required/allowed modifier uses.
As of January 1, 2019, new CPT codes created by the American Medical Association (AMA) are available for qualified healthcare providers (QHP) and psychologists to use for billing insurance related to psychological and neuropsychological testing services.
In conjunction with the release of these new codes, the American Psychological Association (APA) released education material regarding how to utilize the codes, including a billing and coding guide which provides guidance on how to use the new codes in applicable situations.
This new structure made distinctions between administration, interpretation, and professional evaluation, as well as the work performed by a QHP or by a technician under supervision.
Here are key distinctions made in the guide:
The descriptor for CPT Code 96132 is:
Neuropsychological testing evaluation services by physician or other qualified healthcare professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s) when performed, first hour.
A QHP may receive reimbursement for providing neuropsychological testing evaluation using CPT code 96132.
Neuropsychological testing evaluation involves several services, such as:
A variety of qualified healthcare providers (QHP) can bill for CPT 96132 after administering neuropsychological assessments.
A technician may also administer the neuropsychological assessment, but there are a few additional details to keep in mind:
See the Medicare Benefit Policy Manual, Chapter 15, Section 80.2 for more information regarding QHPs.
Please note that the scope of practice for each practitioner type may depend on the State the service takes place in. Always check with the payer to make sure the providers at your practice qualify for reimbursement in your region.
The Medicare payment rate for CPT code 96132 in 2024 is $126.07, before adjustment. Please note: the precise reimbursement rate you receive depends on geographical adjustments and other factors.
For more detailed information, refer to the 2024 CMS Medicare Physician Fee Schedule National Payment Amounts, Non-Facility Price.
Payer coverage varies across public and private payers, and varies by State, so it's best to check with a patient’s carrier to ensure their plan provides coverage of this service.
Receiving reimbursement for your services using CPT code 96132 requires proper documentation in the patient’s records. In order to comply with established time requirements, providers must spend at least 31 minutes performing services related to this code.
When computer-generated interpretations are used as part of a battery of tests (i.e., two or more tests), they are integrated with other data by the QHP using evaluation services codes (96132-96133).
Documentation for neuropsychological testing is payer dependent, but might include:
When billing for multiple services delivered on the same date, you may additionally be required to document the medical necessity of performing separate, non-overlapping test administration, scoring, and/or evaluation services in close proximity with other services.
The latest CPT code guidelines from the National Correct Coding Initiative (NCCI) also recognize that test evaluation includes time spent by doctors outside of in-person sessions with patients, and therefore may take place over several days.
Test evaluation steps completed outside of in-person sessions can include time spent:
Here’s an example of how billing and reimbursement may apply in a typical patient workflow.
Note that these amounts are estimates from the 2024 CMS Medicare Physician Fee Schedule National Payment Amounts, Non-Facility Price. Actual rates will differ based on locality.
Always check with your insurance provider regarding limits on the use of each CPT code for your practice. Reimbursement varies based on factors ranging from the practitioner administering services to regulations depending on your location.
Examples of limits for CPT Code 96132 include:
Codes related to cognitive testing and evaluation often cannot be used for the same encounter when more general evaluation and management codes, such as 99308 or 99483, are also used.
Speaking to certified professional coders and your local payers ahead of billing is the best way to select the codes that are most applicable to your practice.
Modifier codes may be needed to submit multiple codes, depending on the specific services administered and their timing. For example:
For more information, please refer to a certified professional coder or other relevant industry guidance for how to bill for multiple assessments on the same date of service. As always, it is best to check with a payer to determine the necessity of a modifier.
In January 2019, the AMA announced that CPT codes were being modified to better accommodate emerging scientific and technological advancements, which may include online assessment tools like Creyos Health.
Billing for Creyos Health using CPT Code 96132 (and 96133 for additional hours) may include:
Additional reimbursement through codes such as 96136, 96138, and 96146 are dependent upon respective payer coverage policies and relevant medical necessity criteria.
Creyos Health provides a suite of neuropsychological assessments that can support a practice in expanding their available services and improving patient health outcomes. When considered a medical necessity, Creyos neuropsychological assessments may qualify for reimbursement under CPT code 96132.
Creyos Health also provides comprehensive reporting and documentation that are compliant with most payers billing requirements. Remember to always check with payers to ensure your practice qualifies for reimbursement.
Creyos Health can play a key role in making billing easy, such as:
A few key resources can assist you in making billing easier:
Healthcare providers can have different experiences with billing for neuropsychological evaluations, cognitive tests, and related services. We would greatly appreciate it if you could share any of your experience, whether consistent with this article or you had to take different steps. Reach out any time to discuss reimbursement.
The information contained in this document is provided to help you understand the reimbursement process. It is not intended to increase or maximize reimbursement by any payer. We strongly suggest that providers consult their payer organizations with regard to local reimbursement policies.
The information contained in this document is provided for informational purposes only and represents no statement, promise or guarantee by Creyos concerning levels of reimbursement, payment or charge. Similarly, all CPT®, HCPCS Level II® and ICD-10-CM codes are supplied for informational purposes only and represent no statement, promise or guarantee by Creyos that these codes will be appropriate or that reimbursement will be made.