Psychological and Neuropsychological Testing Evaluations, Test Administration and Scoring and Neurobehavioral Status Examinations

Date: 04/29/19

As a reminder, Superior HealthPlan posted the following article on December 26, 2018:  Effective January 1, 2019: Behavioral Health Benefit Updates.

As a follow up to this communication, please see additional details related to the specifications of the benefit limits and billing guidance related to the new codes:

Testing Evaluation and Status Examination

• Procedure Codes 96130, 96131 - Psychological Testing Evaluation
• Procedure Codes 96132, 96133 - Neuropsychological Testing Evaluation
• Procedure Codes 96116, 96121 - Neurobehavioral Status Examination

Important billing information:

• Unit Billing = 1 hour
• No prior authorization is required for testing evaluation or status examination services.
  • If evaluation or examination service exceeds 4 hours/day or 8 hours/year, prior authorization is required for payment consideration.
• Psychological and neuropsychological testing evaluation services include:
  • Face-to-face evaluation and interactive feedback.
  • Interpretation and report or automated result.
• Initial testing evaluation service codes (96130, 96132, 96116) should be billed to include the first hour of service, indicating the date of service of the face-to-face visit.
  • Billing may indicate the face-to-face evaluation only, or may include the interpretation and report preparation services as well, if completed in the first hour of service.
  • Billing for these codes should reflect 1 unit of service.
  • Billing multiple units of service with these codes will be rejected as billing error.
• Add on service codes (96131, 96133, 96121) should be billed for each additional hour, billed as separate line items on the claim, in addition to the primary service code.
  • Billing for the additional hour(s) of service should reflect the actual date for those services.
    • Billing may include face-to-face services that exceed 1 hour, and/or include interpretation and report preparation services completed in each additional hour.

Test Administration and Scoring – Prior Authorization Required

• Procedure Code 96136
  • Psychological or Neuropsychological Test administration and scoring
  • 2 or more tests, any method
  • Physician or other health care professional
  • First 30 minutes (1 unit = 30 minutes)
• Procedure Code 96137
  • Psychological or Neuropsychological Test administration and scoring
  • Physician or other health care professional
  • 2 or more tests, any method
  • Each additional 30 minutes (1 unit = 30 minutes)
• Procedure Code  96138
  • Psychological or Neuropsychological Test administration and scoring
  • 2 or more tests, any method
  • Technician
  • First 30 minutes (1 unit = 30 minutes)
• Procedure Code 96139
  • Psychological or Neuropsychological Test administration and scoring
  • 2 or more tests, any method
  • Technician
  • Each additional 30 minutes (1 unit = 30 minutes)
• Procedure Code 96146
  • o    Psychological or Neuropsychological Test administration, with single automated, standardized instrument via electronic platform, with automated result only.
    • If test is administered by physician or other qualified professional, do not use this code (to report, see 96127, 96136, 96137, 96138, 96139).

Psychological or Neurobehavioral Evaluation and Test Administration Code Edits

• Billing maximum units for any combination of these services for each member, any provider:
  • 4 units (hours)/day
  • 8 units (hours)/calendar year

• Billing for these services is included in the Medicaid Program limitation of 12 hours of behavioral health services, per day/per provider.
• Billing for these services will be denied as part of another procedure on the same day when billed in addition to procedure code 90870 by any provider.
• Billing for these services will be denied when billed on the same date of service as the Texas Child and Adolescent Needs and Strengths (CANS 2.0) Comprehensive (Child Welfare) Assessment (CPT 90791, modifier TJ).
• Psychiatric Diagnostic Evaluations (Procedure Codes 90791, 90792) can be billed the same day as CANS 2.0 Assessment and/or Psychological or Neurobehavioral Testing Assessment, Evaluation or Test Administration (CPT 96116-96146).

Please note: Consistent with Medicaid Program limitations, Psychological, Neurobehavioral, and Neuropsychological Testing will not be reimbursed to an Advanced Practice Registered Nurses (APRN) or a Physician’s Assistant (PA). The most appropriate office encounter/visit procedure code must be billed. Mental health screening may be performed during an assessment by an APRN or a PA, but will not be reimbursed separately.

For questions or more information, please reach out to your dedicated Account Manager.