Disclaimer
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.
2019 Updates to Neuropsychological Testing and Evaluation CPT Codes
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:
- CPT Codes 96130–96133: 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.
- CPT Code 96138: Psychological or neuropsychological test administration and scoring by technician (i.e., two or more tests) any method; first 30 minutes.
- CPT Code 96146: Used for a single, automated test administered via electronic platform that produces an automated report. This new code was created to distinguish between providing a limited, single psychological or neuropsychological automated test versus providing a robust battery of tests. (E.g., brief testing for given condition, monitoring progression of disease or condition, monitoring of response to intervention, etc.) Do not report 96146 for administration of 2 or more tests and/or if test administration is performed by a professional or technician.
Defining CPT Code 96132
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.
What Services Can Be Billed Using CPT Code 96132?
A QHP may receive reimbursement for providing neuropsychological testing evaluation using CPT code 96132.
Neuropsychological testing evaluation involves several services, such as:
- Integration of patient data
- Interpretation of cognitive assessment results, standardized test results and clinical data
- Clinical decision making
- Treatment planning next steps and reporting
- Interactive feedback to the patient, family members or caregivers
Who Can Bill for CPT Code 96132?
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:
- Separate CPT codes for test administration, such as 96138 (for two or more tests) or 96146 (for a single test) may be required
- Subsequently, a physician or other qualified provider may then perform the interpretation, decision making, and communication with the patient
- Total time spent on interpretation, decision making, and patient communication must be equivalent to 31–60 minutes
- Each additional hour spent performing test interpretation, decision making, and patient communication may be billed under CPT code 96133
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.
What is the Expected Reimbursement Value for CPT 96132 in 2024?
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.
What Does Payer Coverage Look Like For CPT 96132?
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.
What are the Documentation and Diagnosis Requirements for CPT 96132?
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:
- Rationale for testing explanation of medical necessity
- Description of the tasks administered and rationale
- Summary of the patient’s relevant medical history
- Report showing test scores and percentiles in relation to the population
- Breakdown of the report interpretation
- Description of resulting clinical decisions, additional assessments, medication or treatment plan changes, or referral to specialists
- Summary of feedback provided to the patient or caregivers
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:
- Reviewing patient information
- Choosing tasks and assessments to administer
- Documenting the test results and interpretation
Billing Example for CPT Code 96132
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.
What are the Limits on CPT 96132?
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:
- Pre-authorization requirements
- Total number of hours one provider can bill for
- Separate codes required for additional hours spent
- Separate codes for psychological or psychiatric services delivered during the same visit
- Modifier codes for services administered on the same or over several visits
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.
CPT Codes Related to 96132: How Do I Bill Multiple Codes?
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.
- Each additional hour of neuropsychological testing (96133)
- First 30 minutes of test administration and scoring performed by a physician (96136–96137)
- First 30 minutes of neuropsychological test administration performed by a technician (96138–96139)
- Automated testing administration completed by a patient without interaction with the physician (96146)
- Cognitive care planning (99483)
- Emotional or behavioral assessment with scoring and documentation (96127)
- In-office evaluation of an established patient, depending on health risk factors (99212, 99213, 99214, 99215)
Using Modifier Codes
Modifier codes may be needed to submit multiple codes, depending on the specific services administered and their timing. For example:
- Modifier code 59 may be used when submitting an E/M code (CPT codes 99202 to 99499) for the visit, along with two distinct services performed for the patient, including 96132.
- If additional services are performed, code 25 may be a more appropriate modifier for the selected E/M code.
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.
Creyos Health Reimbursement Under Code 96132
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:
- Time spent reviewing the automated PDF reports
- Interpreting neuropsychological assessment results
- Discussing the assessment with patient(s), family member(s), or caregiver(s).
Additional reimbursement through codes such as 96136, 96138, and 96146 are dependent upon respective payer coverage policies and relevant medical necessity criteria.
How Creyos Health Makes Billing Easy
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:
- Delivering a comprehensive report that documents assessment results, date of administration, patient details, etc.
- Generating easy-to-read reports that aid in interpretation of standardized results, interactive feedback with the patient, clinical decision making, and treatment planning.
- Seamless documentation (and full integration, in some cases) within an EHR for record-keeping and future reference.
- Complementing other assessment results in order to aid in diagnosis, thereby proving medical necessity for other services that may be billed during the same session or at a later date.
- Combining mental health assessments for depression, anxiety, and ADHD in the same platform as cognitive assessments, so that mental health questionnaires can justify the need for cognitive testing, and vice versa, with a single email to a patient.
A few key resources can assist you in making billing easier:
- Assessment Reports: Automatically generated after each assessment, our easy-to-read reports support results interpretation, patient communication, clinical decision making, and treatment planning.
- Creyos Results Interpretation Guide: Offers a list of circumstances that may indicate that a neuropsychological assessment is medically necessary, and supports the accurate interpretation of Creyos Health assessment reports.
- Creyos Task Selection Guide: Offers more information on the application of specific tasks and questionnaires and their relationships with certain disorders.
Questions Or Comments?
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.
Disclaimer
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.
References
- American Psychological Association: 2019 Psychological and Neuropsychological Testing Billing and Coding Guide
- Billing and Coding for Health Behavior Assessment/Reassessment and Psychological or Neuropsychological Testing Services on the Same Date of Service
- American Psychological Associate: Psychologists’ Testing Codes Have Changed
- PerformCare: Guidelines for Psychological, Developmental, and Neuropsychological Testing