On January 1, 2019, new billing codes for psychological and neuropsychological testing services went into effect. The old codes, 96101–96103 and 96119–96120, were eliminated on December 31, 2018. Updated resources for this set of codes are at Psychological and Neuropsychological Testing Codes for Psychologists.
In this article, psychology and legal experts at APA address the most pressing questions submitted by members following the 2019 release of the family of testing codes.
Where/when will the Relative Value Units (RVUs) be posted?
RVUs are released by the Centers for Medicare and Medicaid Services (CMS) every November and are made available on their Physician Fee Schedule Federal Regulation Noticesopens in new window page.
Are procedure codes to use for all insurance companies?
Yes. Medicare and private insurers provide reimbursement for all services, including testing services.
Do base and add-on codes have different rates of reimbursement?
Yes. Differences are detailed in the final rule released by CMS in November.
How are students or postdoctoral trainees who provide test administration and/or scoring services while supervised by licensed psychologists treated in the 2019 coding structure?
Specific guidance for assessment provided by unlicensed trainees under the supervision of licensed psychologists and neuropsychologists is not addressed by the 2019 coding structure. This is something that is decided by Medicare, Medicaid, and other third-party payers. CMS has specifically stated that under the Medicare Physician Fee Schedule there is no payment for services performed by students or trainees. Accordingly, Medicare does not pay for services when performed by a student or a trainee. This position did not change with implementation of the revised testing codes.
Can you use both a technician and a professional for administration and scoring with the same client/claim or does it have to be one or the other?
You should use the code or codes that best describe the actual work taking place. If both a technician and a psychologist are doing some of the administration and scoring on the same evaluation, then yes, both codes should be used, documenting the time spent by each.
Could you provide any examples of what types of testing would typically be considered billed under 96116 and 96121?
96116 and 96121 are the CPT codes for Neurobehavioral Status Exam. The neurobehavioral status exam is a clinical interview examination that might include use of some brief behavioral measures to determine the individual’s mental status. It typically does not involve administration of neuropsychological tests, which would be subsumed under the test administration and scoring codes.
Psychologists who have questions about billing, coding, or reimbursement issues should contact APA’s Office of Health and Health Care Financing.