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How to Bill Using CPT Code 96132 for Neuropsychological Testing in 2021: A Guide for Psychologists and Physicians

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Please note that Cambridge Brain Sciences can not determine your eligibility for reimbursement and does not assume responsibility over the outcome of any claims. The selection of CPT codes noted below to report the services provided will depend on other procedures performed, associated CCI edits, and other factors.

Please contact your local payer to determine whether you qualify for these codes, and if any additional coding and coverage guidelines exist, such as which providers can perform the service, limits on billable time, or if the use of a modifier is required or allowed.


What services can be billed using CPT code 96132?

Neuropsychological testing evaluation involves services such as interpreting the results of cognitive assessments, integrating patient data, and planning next steps.Qualified healthcare providers may receive reimbursement for providing neuropsychological testing evaluation using CPT code 96132.

The Centers for Medicare and Medicaid Services (CMS) announced in 2019 that CPT codes were being modified to better accommodate emerging scientific and technological advancements, which may include online assessment tools like CBS Health. Some of our customers have had success receiving reimbursement for CBS Health assessments using CPT code 96132, which is designated as:

Neuropsychological testing evaluation. Includes integration of patient data, interpretation of results and clinical data, clinical decision making, treatment planning and report by a healthcare professional.

Billing for CBS Health using this code may include the time spent reviewing the PDF reports, interpreting results, and discussing the assessment with the patient or the patient’s family. In many cases, 96132 (and 96133 for additional hours) are the codes that our customers use to receive reimbursement for the interpretation of CBS Health with patients. The time that a healthcare provider spends on evaluation services billed using 96132 may be distinct from the actual administration of a neuropsychological battery. Codes such as 96136, 96138, and 96146 may result in additional reimbursement for the initial administration of the assessment.


Who can bill for CPT code 96132?

A variety of qualified healthcare providers can bill for CPT 96132 after administering neuropsychological assessments.

There is a high-level requirement for a clinical psychologist or a physician, such as a psychiatrist or neurologist, to supervise diagnostic tests. However, exceptions are made for nonphysician practitioners, such as clinical nurse specialists and physician assistants, when under the general supervision of a physician or clinical psychologist. Physical therapists, occupational therapists, and speech language pathologists may also have the necessary qualifications for certain codes. Independent psychologists who are not clinical psychologists may qualify as well, when a physician has ordered testing.

When a technician administers a neuropsychological assessment, separate CPT codes such as 96138 may be billed. A physician or other qualified provider may then perform the subsequent interpretation, decision making, and communication with the patient and bill using 96132.

See the Medicare Benefit Policy Manual, Chapter 15, Section 80.2 for more information, and note that the scope of practice for each type of practitioner depends on the state the service takes place in, so always check with the payer to make sure the providers at your practice qualify for reimbursement in your location.


What are the documentation and diagnosis requirements for CPT 96132?

Receiving reimbursement for your services using CPT code 96132 may require proper documentation in the patient’s records.

Documentation for neuropsychological testing generally includes:

  • Reason for testing and explanation of medical necessity (see our Results Interpretation Guide for a list of circumstances that may indicate a neuropsychological assessment is necessary)
  • The tasks administered and reasons for those tasks (see our Task Selection Guide for more information on tasks and their relationships with certain disorders)
  • The patient’s relevant medical history, if any
  • The report showing scores on each test, and percentiles in relation to the population (such as those shown on the CBS Health reports, automatically generated after each assessment)
  • Interpretation of the report (see our Results Interpretation Guide for assistance with interpreting CBS Health reports)
  • Clinical decisions made as a result of the testing, such as additional assessments, medication changes, or referral to specialists
  • Changes to a treatment plan as a result of the testing
  • Summary of feedback provided to the patient or caregivers

When billing for multiple services on the same date or the same encounter, you may also be required to document the medical necessity of performing separate, non-overlapping test administration, scoring, and/or evaluation services in close proximity with other services (e.g., health behaviour assessment or reassessment), over and above the medical necessity of the assessments themselves.

Note that the latest CPT code guidelines recognize that test evaluation includes time spent by doctors aside from in-person sessions with patients. Time spent reviewing patient information, choosing tasks to use, and documenting the test results are part of test evaluation. The NCCI and many insurers have recognized that these steps billed using code 96132 may take place over several days (see the APA’s guidance for more detail), and most of our customers have billed for the code on the date of the final activity.


Can CPT 96132 be used as part of a telehealth program in 2021?

The telehealth landscape has changed rapidly and substantially as a result of the COVID-19 pandemic. One change that has benefited healthcare providers is a relaxation of restrictions that made billing difficult or impossible for certain services provided remotely via telehealth.

CPT code 96132 is not included in CMS’s list of permanent telehealth services, but is included in the expanded list of services payable when furnished via telehealth for the COVID-19 pandemic. For now, telehealth interactions with patients are covered, including audio-only interactions. Code 96132 is set to expire as a telehealth service at the end of the year in which the COVID-19 public health emergency is declared over. Refer to the CMS.gov public health emergencies page for current information when billing for telehealth services.

See our related blog post for more detail: Expanded Telehealth Benefits Due to COVID-19.


What are the limits on CPT 96132?

Always check with Medicare or other insurance providers regarding limits on the use of each CPT code for you—restrictions and regulations differ depending on your location.

There may be limits on the total number of hours that one provider can bill for in one day or one year for 96132 alongside other related codes for psychological and psychiatric services, although in some cases multiple services may be billed for the same date with the proper modifier code and documentation. The modifier code will depend on if the services were administered in the same encounter (i.e., the patient did not leave between services) or the same date (i.e., the patient left and came back on the same day)—see below for more information on combining codes. Additional hours may be reimbursed with prior authorization, when medical necessity can be demonstrated, according to the APA.

Codes related to cognitive testing and evaluation often cannot be used for the same encounter when more general evaluation and management codes, such as 99308 or 99483, are also used (source: Savonix).


What are other CPT codes related to 96132 and how do I bill multiple codes?

The code most often billed with 96132 is 96133, for each additional hour of neuropsychological testing. Add-on codes for additional time must always be billed with their corresponding primary procedure code.

The following codes may cover the initial administration of assessments, without any of the planning or interpretation time covered by 96132.

  • 96136: for the first 30 minutes of test administration and scoring performed by a physician (and 96137 for each additional 30 minutes).
  • 96138: for the first 30 minutes neuropsychological test administration performed by a technician (and 96139 for each additional 30 minutes).
  • 96146: if the patient takes the test at home with no interaction with the physician, this code for automated testing may be more appropriate.
  • 96130: used to bill for the first hour of psychological testing evaluation services (then 96131 for each additional hour).
  • 96116: neurobehavioral status exam, pre-test evaluation in-person by a healthcare professional; if a physician has to be with the patient during testing, this code may be most appropriate for the first hour of interaction.

Additional codes for a visit with a patient that may include CBS Health:

  • 96127: brief emotional / behavioural assessment with scoring and documentation, per standardized instrument, such as the PHQ-9 and/or GAD-7 included in CBS Health. As of early 2021, this code has been permanently approved for use with telemedicine by CMS.
  • 99213, 99214, or 99215: evaluation and management of an established patient in an office our-patient location for 15 minutes, for low, moderate, or high complexity and risk, respectively.

When submitting multiple codes for administration and interpretation of neuropsychological tests, submitting both codes on the same day has led to successful reimbursement for CBS Health customers. Modifier codes may be needed to submit multiple codes, depending on the specific services administered and their timing. For example, modifier code 59 may be used when submitting 99214 for the visit, along with two distinct services performed for the patient, including 96132. If additional services are performed, code 25 may be a more appropriate modifier for 99214. For more information, see the APA’s advice for billing multiple assessments on the same date of service.


What is the expected reimbursement value for CPT 96132?

The precise reimbursement you receive depends on geographical adjustments and other specifics. Before adjustment, the Medicare payment for CPT 96132 is $133.71 for 96132 and $101.99 per additional hour using 96133 (sources: Philips, Savonix).


What is the role of CBS Health in billing for CPT code 96132?

Many healthcare providers bill for administering a CBS Health protocol to a patient as a neuropsychological assessment, providing income for the practice and ensuring that any investment in CBS Health has a positive return.

Aside from direct reimbursement for an assessment, CBS Health can play a key role in making billing easy, such as:

  • Providing a report that documents the results of an assessment, as well as metadata such as the time an assessment was administered, for easy documentation in an EHR or future reference.
  • Generating easy-to-read reports that aid in interpretation of standardized results, interactive feedback with the patient, clinical decision making, and treatment planning, all of which fall under the time billed for CPT code 96132.
  • Complementing other assessment results in order to aid in diagnosis, thereby proving medical necessity for other services that may be billed during the same session or at a later date.
  • Combining mental health assessments for depression, anxiety, and ADHD in the same platform as cognitive assessments, so that mental health questionnaires can justify the need for cognitive testing, and vice versa, with a single email to a patient.

Whether you are already using our platform, or are considering adding reimbursable cognitive assessments to your practice, get in touch with us any time to discuss how to best make use of CBS Health.


Questions or comments?

Different providers can have different experiences with billing for cognitive testing and related services. We would greatly appreciate if you could share any of your advice and experience, whether it is consistent with this article or whether you had to take different steps. Reach out any time to discuss reimbursement.


Disclaimer

The information contained in this document is provided to help you understand the reimbursement process. It is not intended to increase or maximize reimbursement by any payer. We strongly suggest that providers consult their payer organizations with regard to local reimbursement policies.


The information contained in this document is provided for informational purposes only and represents no statement, promise or guarantee by Cambridge Brain Sciences concerning levels of reimbursement, payment or charge. Similarly, all CPT®, HCPCS Level II® and ICD-10-CM codes are supplied for informational purposes only and represent no statement, promise or guarantee by CBS that these codes will be appropriate or that reimbursement will be made.


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