Please note that Creyos can not determine your eligibility for reimbursement and does not assume responsibility over the outcome of any claims. The selection of CPT codes noted below to report the services provided will depend on other procedures performed, associated CCI edits, and other factors.
Please contact your local payer to determine whether you qualify for these codes, and if any additional coding and coverage guidelines exist, such as which providers can perform the service, limits on billable time, or if the use of a modifier is required or allowed.
This article was last updated May 18th, 2021.
The COVID-19 pandemic has caused many healthcare providers to rethink how they deliver their services safely and effectively. Many providers are introducing telemedicine, including remote cognitive assessments. As a result, Creyos has received inquiries about reimbursement for telehealth services related to neuropsychological testing. Here, we will provide some of the information we have learned so far, including news on changes introduced as a result of COVID-19.
Restrictions on Telehealth Have Been Relaxed
The telehealth landscape is changing rapidly in response to COVID-19. In the United States, coronavirus legislation from congress quickly gave the Department of Health and Human Services authority to waive certain Medicare telehealth restrictions. For example, certain site limitations are removed, such that existing telehealth services can now be provided regardless of where the patient is located geographically. This CMS fact sheet contains more details.
The duration of any temporary relaxation of restrictions has not been definitely determined, but some changes as a result of the pandemic have been extended through the end of 2021, and some may even become permanent. Some restrictions depend on the declaration of a public health emergency—check the U.S. Department of Health & Human Services Public Health Emergency declarations for the latest information.
These changes are designed to allow qualified healthcare providers to provide services to patients at home, helping to keep in-person visits to a minimum and slow down the spread of the virus. Creyos Health’s remote cognitive testing is one tool that may help you continue to perform assessments you would have previously done in-clinic. See our Best Practices for Assessing Patients Remotely article for more advice on switching to email assessments.
What Has Changed With CPT Codes Related to Remote Cognitive Assessments?
Many qualified Creyos Health customers are already successfully receiving reimbursement for various services related to cognitive assessments. The Creyos Health Reimbursement Guide describes some CPT codes related to the administration of the cognitive assessment itself, as well as other related activities such as exams before assessments, and providing feedback on results after assessments.
One CPT code relevant to the recent changes is 96116. CPT code 96116 covers neurobehavioural status exams. A Creyos Health baseline assessment may be part of this exam. Code 96116 was already listed as a telehealth service, but under new telemedicine guidelines, can be administered remotely in more situations than before. If you are a physician or other qualified healthcare professional, and administer cognitive assessments as part of a neurobehavioural status exam, you may be eligible for reimbursement using code 96116.
CPT code 96132, for neuropsychological testing evaluation, is another code commonly used by Creyos Health customers. As a result of the pandemic, codes 96130-96133 and 96136-96139, all related to testing and evaluation, have been added as telehealth codes until at least the end of the year in which the public health emergency is declared over (source: CMS). See our guide to CPT code 96132 for more information on this code.
Another CPT code used by some providers when administering remote cognitive assessments is 96146: psychological or neuropsychological automated testing using an electronic platform. While this code is not listed as a telehealth service by CMS, you may wish to check with your local payer to see if this applies to your practice specifically when administering cognitive assessments remotely.
Note that CPT codes 99421-99423 (for physicians) and codes G2061-G2063 (for other titles, such as clinical psychologists and occupational therapists) already existed for online digital evaluation and management of established patients. There are no geographic or location restrictions for these e-visits. See the CMS website for more details.
At a state level, depending on your type of practice, title, and location, there may now be additional codes that are relevant to telehealth. Certain states have lifted restrictions on codes beyond those already marked as telehealth services. For example, the West Virginia Department of Health and Human Resources specifically allowed psychological testing services to be administered through telehealth early in the pandemic, which affected CPT codes 96113, 96130, 96131, 96132, 96136, and 96146 (source).
As always, let us know if we can help. Our teams are happy to meet with you one on one to share any information we have learned from other customers. To book a time with a Creyos team member, please click here.