Reimbursement

HOW TO USE CPT CODES FOR NEUROPSYCHOLOGICAL/COGNITIVE TESTING AND CALCULATE REIMBURSEMENT

In January of 2019 CPT codes were revised with some new codes and others that were removed. The following document will review what those codes are for Neuropsychological testing along with descriptors, and what factors are used in calculating the reimbursement by insurance payers.

The factors used to calculate the amount of reimbursement are based on the code number (96XXX) and the associated RVU (Relative Value Unit). The RVU is then multiplied by the CF (Conversion Factor). For purposes of this document the CF will be $36.0391, however, CFs will vary by geographical location. Please check your location for exact CF amounts.

Psychological/Neuropsychological Testing

All codes listed below can be administered either face to face or via Tele-Health

Neurobehavioral Status Exam

96116

Neurobehavioral status exam (clinical assessment of thinking, reasoning, and judgement, e.g., acquired knowledge, attention, language, memory, planning, and problem solving, and visual spatial abilities), by physician or other qualified health care professional, both face-to-face time or via Tele-Health with the patient and time interpreting test results and preparing the report; first hour: RVU 2.70

+96121 (add on code for 96116)

Each additional hour (List separately in addition to code for primary procedure)
RVU 2.32

Test Evaluation Services

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: RVU 3.30

+96131 (add on code for 96130)

Each additional hour (List separately in addition to code for primary procedure)
RVU 2.51

96132 (formerly 96118)

Neuropsychological testing (e.g., Cognistat, Halstead - Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), 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: RVU 3.7

+96133 (add on code for 96132)

Each additional hour (List separately in addition to code for primary procedure)
RVU 2.83

Test Administration and Scoring

96136 (formerly 96118)

Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method, first 30 minutes: RVU 1.33

+96137 (add on code for 96136) Each additional 30 minutes (List separately in addition to code for primary procedure): RVU 1.23

96138 (formerly 96119)

Psychological or neuropsychological test (e.g., Cognistat, Halstead - Reitan Neuropsychological Battery,
Wechsler Memory Scales, and Wisconsin Card Sorting Test), administration and scoring by technician, two or more tests, any method; first 30 minutes: RVU 1.08

+96139 (add on code for 96138)

Each additional 30 minutes (List separately in addition to code for primary procedure): RVU 1.08

Reimbursement Amount Table

Typical Use Case Billing Examples

1. Estimated reimbursement with neurobehavioral status exam prior to neurocognitive test administration.

2. Estimatedreimbursement,byTechnician

3. Estimatedreimbursement,testadministrationbyphysician.

DISCLAIMER: The information provided in this document was obtained from third-party sources and is subject to change without notice as a result of changes in reimbursement laws, regulations, rules, and policies. All content on this document is informational only, general in nature, and does not cover all situations or all payers’ rules and policies. This content is not intended to instruct medical providers on how to use or bill for healthcare procedures, including new technologies outside of Medicare national guidelines. A determination of medical necessity is a prerequisite that Cognistat assumes will have been made prior to assigning codes or requesting payments. Medical providers should consult with appropriate payers, including Medicare fiscal intermediaries and carriers, for specific information on proper coding, billing, and payment levels for healthcare procedures. This information represents no promise or guarantee by Cognistat. concerning coverage, coding, billing, and payment levels. Cognistat specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on this information.