Guidance unique to billing and coding for testing services

The National Correct Coding Initiative (NCCI) edits help CMS prevent improper payments by ensuring that correct coding methodologies are used.

Edits exist that affect how psychologists bill for assessments occurring over multiple days as well as billing for test administration by technicians and psychologists on the same day. The following information is intended to guide psychologists on using codes for billing in these particular situations.

How do I bill for testing evaluation services (96130-96133) and/or test administration and scoring services (96136-96139) across multiple dates of service?

When a service is spread out over multiple visits, the total time for the evaluation should be reported at the completion of the entire episode of the evaluation (Medicare NCCI Add-on Code Editsopens in new window, CMS). The single bill should list both base and add-on codes with the different dates of service for the entire episode of evaluation. A base code should only be submitted for the first unit of each type of service of the evaluation process. Subsequent units of service on the same or different days should be captured using add-on codes.

How do I handle billing if both a technician and a psychologist perform test administration and scoring on the same day with the same patient?

There is an NCCI edit in place that prevents Test Administration and Scoring services by a psychologist (codes 96136/96137) and a technician (codes 96138/96139) to be billed on the same day with the same patient without appending an appropriate modifier.

The modifier serves to demonstrate that the psychologist and the technician performed separate, distinct, and nonoverlapping test administration and scoring services (as evidenced in the documentation); however, choosing the appropriate modifier depends on how the test administration and scoring services were provided to the same patient on the same date of service (CMS MLN MLN1783722 [PDF, 224KB])opens in new window.

• For 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 test administration 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 test administration performed by the technician, Modifier XE would be appended to the base code for the second encounter of testing services.
• For testing services that are performed during the same encounter on the same date of service, Modifier 59 should be used. For example, the psychologist begins administering the test battery and then the technician takes over (i.e., the patient doesn’t leave the office), Modifier 59 would be appended to the base code for the second test administration and scoring service.

It should also be noted that if both a psychologist and a technician (under the supervision of the psychologist) provide test administration and scoring services with the same patient but on different dates of service, no modifier is required to be reported on the claim form.

How can I work with my private insurance company or Medicaid agencies and managed care companies to ensure that they are uniformly applying the NCCI edits and other testing code guidance?

The APA Services resource Psychological and Neuropsychological Testing Billing and Coding Guide (PDF, 268KB)opens in new window provides a comprehensive overview of the structure, function, and utilization of the new code set to eliminate problems and inconsistencies encountered since the implementation of these codes.

This resource is intended to serve as a reference to insurers in the development of billing and coding policies, claims adjudication process, and production of consistent guidance and educational resources, as well as help to eliminate problems experienced by psychologists and neuropsychologists.

APA strongly advises that psychologists experiencing billing, coding and/or reimbursement issues with a particular payer consult with their state psychological associations and/or with APA staff experts instead of sending the guide to the payer. Advocacy efforts with payers are more effective in coordination with your state psychological association and/or APA. Psychologists who continue to have questions about the guide or wish to report billing or reimbursement problems they’re experiencing are encouraged to notify APA’s Office of Health and Health Care Financingopens in new window.