In September, the nation’s largest managed behavioral health care organization announced that it will adopt APA’s 2019 Psychological and Neuropsychological Testing Billing and Coding Guide as guidance on the clinical criteria it will use to make coverage decisions about testing services. Optum, which provides behavioral health care to 34.5 million Americans, will put the new policy into effect January 1, 2021.
By adopting the guide, Optum has decided to let the experts—psychologists and neuropsychologists—have their say on which psychological and neuropsychological testing services should be covered. That’s good news for psychologists and their patients, says Stephen Gillaspy, PhD, senior director of APA’s Office of Health Care Financing. “It’s really important that insurance companies don’t set those standards but that you have clinicians and medical societies like APA being able to weigh in on issues like when the services we provide are medically necessary,” says Gillaspy.
Developed by APA’s Testing Advisory Group and APA Services, Inc. staff, the guide was a response to the new psychological and neuropsychological testing CPT® codes that went into effect in 2019. To help both commercial and government payers as well as providers navigate those changes, the guide serves as a blueprint for developing billing and coding policies, claims adjudication processes, and the production of educational resources. The guide:
- Describes the new codes
- Provides guidance on how to document services and bill for services, including those that take place over multiple days
- Offers specifics about coverage indications, limitations of coverage, and medical necessity
The final section features the scientific evidence that supports the guide’s recommendations and additional educational resources.
A billing and coding guide addendum (PDF, 327KB) provides three examples of how to code, document, and bill for testing services. Based on the most common concerns reported by APA members since the new codes went into effect, the examples walk users through entire episodes of care, including selecting a test, interviewing the patient, administering and scoring the test, writing a report, and giving feedback to the patient, family, and referring physician.