Up to code: 2019 Testing code changes

In July 2018, APA began notifying members that significant changes were coming to the Medicine/Central Nervous System Assessments/Tests subsection of the Current Procedural Terminology (CPT^®) code set, otherwise referred to as the Psychological and Neuropsychological Testing Codes. Since those changes went into effect on January 1, 2019, APA has continued to monitor utilization of the codes, respond to billing and coding issues reported by providers and insurers, and develop tools to support psychologists and neuropsychologists that utilize this code set.

The updated family of codes that went into effect in 2019 were part of a modernized coding structure that more accurately described the work required when multiple hours of technical and professional services are performed These changes included:

• 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

The 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, 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 services; however, it will be important to pay close attention to the units of time stated in each code descriptor, as they can vary from code to code.

Psychological and neuropsychological testing evaluation services are to be performed and reported by a professional, using codes 96130, 96131, 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 test administration services. Additionally, regardless of whether the professional or a technician performs test administration and scoring, evaluation services must always be performed by the professional, and may be billed on the same or different days.

Test administration and scoring services are reported with codes 96136/96137 when performed by a psychologist/neuropsychologist and 96138 /96139 when performed by a technician. When additional time, beyond the initial 30 minutes, 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 associated 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 report add-on code 96139 for each additional 30-minute increment.
• Single automated test administration: Code 96146 should be reported for a single automated psychological or neuropsychological instrument that is administered via electronic platform (e.g. computer) and formulates 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.

If you have questions about proper coding, billing, and reimbursement, please direct them to APA’s Office of Health and Health Care Financing.