Patients needing health behavior assessment or reassessment (CPT® code 96156) sometimes also require psychological/neuropsychological testing and scoring (CPT codes 96136, 96138, 96146) and/or evaluation services (CPT codes 96130, 96132). These services are often provided on the same date of service by the same psychologist. Because Medicare does not ordinarily see two types of psychological services delivered to the same patient on the same date of service, a National Correct Coding Initiative (NCCI) edit is in place that prevents the services from being billed together without an appropriate modifier and corresponding documentation.
Billing and coding for Health Behavior Assessment/Re-Assessment & Psychological or Neuropsychological Testing Services on the same date of service
The modifier serves to demonstrate that, following the completion of the health behavior assessment or re-assessment service, the psychologist then performed separate, distinct and non-overlapping test administration and scoring and/or testing evaluation services; however, choosing the appropriate modifier depends on how the assessment or reassessment service and the testing services were provided to the same patient on the same date of service.
For health behavior assessment or reassessment services and testing services that are performed during separate encounters on the same date of service, Modifier XE should be used. For example, if a patient has an initial assessment or reassessment encounter with the psychologist and then leaves the office – possibly to get lunch – but returns to the office later that day for a second encounter of testing services, Modifier XE would be appended to the base code for the second encounter of testing services.
- Modifier XE is used to identify a service that is distinct because it occurred during a separate encounter on the same date of service.
- The submission of Modifier XE appended to a procedure code indicates that documentation is available in the patient’s records that will support the medical necessity of the psychologist performing separate, distinct and non-overlapping test administration and scoring and/or evaluation services during separate encounters on the same date of service as the health behavior assessment or reassessment service.
For health behavior assessment or reassessment services and testing services that are performed during the same encounter on the same date of service, Modifier 59 should be used. For example, if the psychologist performs a health behavior assessment or reassessment immediately followed by administering and scoring a test battery and testing evaluation services (e., the patient doesn’t leave the office), Modifier 59 would be appended to the base code for the test administration and scoring and/or evaluation service.
- Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under certain circumstances and where Modifier XE would not be appropriate.
- Documentation must support the medical necessity of the psychologist performing separate, distinct and non-overlapping test administration and scoring and/or evaluation services during the same encounter on the same date of service as the health behavior assessment or reassessment service.
It should also be noted that if a psychologist provides health behavior assessment or reassessment and test administration and scoring and/or evaluation services with the same patient but on different dates of service, no modifier is required to be reported on the claim form.
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Initial Service Performed |
Secondary Service Performed |
During Separate Encounters CPT Codes & Modifier Reported |
During Same Encounter CPT Codes & Modifier Reported |
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CPT® code 96156; Health behavior assessment, or re-assessment (i.e., health-focused clinical interview, behavioral observations, clinical decision making) |
CPT code 96136; Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes |
96156
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96156
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CPT code 96138; Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes |
96156
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96156
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CPT code 96146; Psychological or neuropsychological test administration, with single automated, standardized instrument via electronic platform, with automated result only |
96156
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96156
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CPT code 96130; Psychological testing evaluation services by physician or other qualified health care 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 |
96156
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96156
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CPT code 96132; Neuropsychological testing evaluation services by physician or other qualified health care 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 |
96156
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96156
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Additional billing and coding scenarios will be added as the need arises. Please check back at a later date for further billing and coding guidance.
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Date created: January 2020