Up to code: Testing code changes are here

By APA Office of Health Care Financing

In July, APA began notifying members that significant changes were coming to the Medicine/Central Nervous System Assessments/Tests subsection of the Current Procedural Terminology (CPT^®) 2019 code set, otherwise referred to as the Psychological and Neuropsychological Testing Codes. Those changes have officially been released and APA continues to work hard to develop tools to support psychologists as they prepare for the new way of coding that begins Jan. 1, 2019. 

The new testing codes, which APA helped develop, are part of a modernized coding structure that more accurately describes the work required when multiple hours of technical and professional services are performed.

As a result of APA’s advocacy work, the new testing codes provide numerous benefits for psychologists delivering these services including:

• A clear differentiation between the professional and technical services (i.e., technical test administration and scoring services versus professional evaluation services).
• A clear differentiation of work performed by a psychologist or neuropsychologist who personally administers tests and technician administered testing.
• A modernization of the code set to distinguish stand-alone, single-computer screening tests from a battery of psychological or neuropsychological tests.

On Jan. 1, 2019, the following CPT codes used to report psychological and neuropsychological testing services will be eliminated: 96101, 96102, 96103, 96118, 96119 and 96120.

The new set of codes (PDF, 37KB) can be found on the Practice Central website in the Reimbursement section. To view APA’s newly developed crosswalks — charts designed to help you determine which CPT code to use for a particular service — and definitions, visit the Psychological and Neuropsychological Testing Codes for Psychologists webpage.

Using stand-alone codes and add-on codes

The new code family includes stand-alone codes that describe the primary or base service, as well as add-on codes that describe additional work and time associated with the primary/base service.

Add-on codes are never reported as stand-alone codes and must always be reported in conjunction with the primary or base service.

For example, when a neurobehavioral status exam is performed, revised CPT code 96116 should be reported by the psychologist for the first hour of service. If the exam is not complete after the first hour, instead of reporting another unit of 96116 the psychologist will report add-on code 96121 for each additional hour required to complete the neurobehavioral status exam.

CPT rules allow an additional unit of a time-based code to be reported as long as the midpoint of the stated amount of time is passed. In this example, once the first hour of the neurobehavioral exam is complete, the professional must perform at least an additional 31 minutes of work to bill the first unit of the add-on code 96121.

These rules apply to all time-based codes in the new code set; however, it will be important to pay close attention to the units of time stated in each code descriptor, as they vary from 30 minutes to one hour.

Billing for professional evaluation services

Beginning January 2019, psychological and neuropsychological testing evaluation services are to be performed and reported by a professional, using codes 96130, 96132 and 96133.

Elements of professional work in the new evaluation service codes include: 

• Integration of patient data.
• Interpretation of standardized test results and clinical data.
• Clinical decision making.
• Treatment planning and report.
• Interactive feedback to the patient, family member(s) or caregiver(s).

For psychological testing evaluation services, the first hour is reported using CPT code 96130 and each additional hour required to complete the psychological testing evaluation service is reported with the add-on code, 96131.

For neuropsychological testing evaluation services, the first hour is reported using 96132 and each additional hour is reported as 96133.

Also included in the psychological and neuropsychological testing evaluation services is the selection of the appropriate test(s) to be administered; therefore, evaluation services (96130/96131 or 96132/96133) must always be billed with any test administration services. Additionally, regardless of whether the professional or a technician performs test administration and scoring services, testing evaluation services must always be performed by the professional, and may be billed on the same or different days.

Billing for test administration and scoring

The new codes for 2019 also reflect the differences between test administration and scoring performed by a psychologist/neuropsychologist versus the same services performed by a technician.

Psychological or neuropsychological test administration and scoring services will be reported with the rest of codes ranging from 96136 to 96139. When additional time is required to complete test administration and scoring, the professional or the technician must spend at least an additional 16 minutes performing the service to bill units of the add-on code.

• Test administration and scoring by a psychologist or neuropsychologist: Report code 96136 for the first 30 minutes, and report add-on code 96137 for each additional 30-minute increment of time required to complete the test administration service.
• Test administration and scoring by a technician: Code 96138 should be reported for the first 30 minutes of technician time, and add-on code 96139 is reported for each additional 30-minute increment.
• Single automated test administration: Newly created code 96146 should be reported for a single automated psychological or neuropsychological instrument that is administered via electronic platform (e.g. computer) and formulates in an automated result. This code is billed only once per session. Do not report this code if two or more electronic tests are administered in a session and/or if administration is performed by the professional or technician.

Learn how to use the new codes: Register for a webinar

Given the significant changes to how testing services will be coded, APA will hold several webinars this fall and again in 2019 to better prepare our members for the transition.

• Oct. 24: Antonio Puente, PhD, and Neil Pliskin, PhD, will discuss the specific testing codes and descriptions, and share practical examples. Register now.
• Dec. 5: Puente and Pliskin will continue to discuss the specific changes to the codes covered in the July and October webinars as well as introduce CMS’s new payment structure. Registration for this webinar opens Nov. 1.

Please visit the APA Practice Central website to for the most up-to-date information on our webinar series and to view past webinars.