Neuropsychological and psychological testing during COVID-19

Clinical psychologists and neuropsychologists whose practices focus on the delivery of testing evaluation and face-to-face test administration and scoring services are facing substantial challenges during the COVID-19 national crisis.

On March 30, 2020 the Centers for Medicare and Medicaid Services (CMS) approved many of APA's recommendations for expanding telehealth coverage including allowing the provision of psychological and neuropsychological testing services via telehealth.

As psychologists continue to work on developing new methods of providing psychological and neuropsychological care via telehealth, APA offers the following suggestions:

• If the case is a "medical" diagnosis — one involving a neurological condition — psychologists should conduct a Neurobehavioral Status Examination and bill code 96116. Note that at this time CMS has not approved the add-on code 96121 for usage via telehealth (though APA has requested its inclusion). When providing testing services, use Current Procedural Terminology (CPT) codes 96132-96133 and 96136-96139, as indicated for Neuropsychological Testing. Please note that these are timed codes.

• For cases regarding mental health diagnosis (e.g., DSM), psychologists should use the Psychiatric Diagnostic Evaluation code 90791. Please note that this is an untimed code. When providing testing services, use CPT codes 96130-96131 and 96136-96139, as indicated for psychological testing. Please note that these are timed codes.

There is an increasing need for psychological services including psychotherapy and health behavior interventions. Psychologists who traditionally offer testing services may wish to consider providing telehealth psychotherapy services as a way to continue serving your referral sources and your patients. Providing these services would also contribute to the psychological health of society during the COVID-19 crisis. 

If a patient's primary diagnosis is a physical health diagnoses, you would use the health behavior codes and if the primary diagnoses is a mental health diagnosis, the psychotherapy codes. Additional resources on how to bill these codes via telehealth during COVID-19 are listed below.

Psychologists can now bill for time spent on audio-only telephones if a patient calls because they are experiencing mental health issues or symptoms. During these calls, the psychologist engages in assessment of the problem (not formal testing) and then provides an intervention service. These are the only services that can be provided by audio-only telephones in Medicare at this time.

Psychologists can also bill for brief communications (known as e-Visits) with established Medicare patients. E-Visits involve a brief communication, typically initiated by the patient and can be furnished in any location or geographic area. Medicare co-insurance and deductible amounts cannot be waived for e-Visits.