October 31, 2005 – In November 2004, the American Medical Association’s (AMA) CPT Editorial Panel announced it would replace the existing Current Procedural Terminology (CPT)® psychological and neuropsychological testing codes with an expanded set of codes beginning Jan. 1, 2006. The existing codes will not be accepted after Dec. 31, 2005.
This question-and-answer guide provides new information about changes to the codes and how to handle billing under the revised codes.
Q: What changes will there be to the existing CPT psychological and neuropsychological testing codes in 2006?
A: The existing CPT codes for psychological and neuropsychological testing have been revised, effective Jan. 1, 2006. New code numbers will replace the existing CPT code numbers 96100, 96117 and 96115 for psychological testing, neuropsychological testing and the neurobehavioral status exam.
The revised psychological and neuropsychological testing codes will now reflect who does the testing: a psychologist, a technician or a computer. The neurobehavioral status exam, which is typically not administered by a technician or a computer, will be replaced by a single new code.
The revised codes will finally provide more appropriate reimbursement and recognition for psychologists who administer psychological and neuropsychological tests. The APA Practice Organization successfully sought the revised codes as part of a persistent, multi-year effort to obtain a “professional work value” for testing and assessment codes reflecting the time and effort expended by a psychologist in providing these services. Previously, psychological testing codes had a work value of zero for the psychologist’s effort.
In 2006, the code for psychological testing, interpretation and reporting, currently known as 96100, will be replaced by:
• 96101, for psychological testing, interpretation and reporting per hour by a psychologist
• 96102, for psychological testing per hour by a technician
• 96103, for psychological testing by a computer, including time for the psychologist’s interpretation and reporting.
Neuropsychological testing, currently known as 96117, will be replaced by:
• 96118, for neuropsychological testing, interpretation and reporting per hour by a psychologist
• 96119, for neuropsychological testing per hour by a technician
• 96120, for neuropsychological testing by a computer, including time for the psychologist’s interpretation and reporting.
The neurobehavioral status exam, currently coded as 96115, will be coded as 96116. There is only a single code reflecting the psychologist’s work in administering the exam, which is typically not administered by a technician or a computer.
The new code numbers are published in CPT 2006©, which is now available from the AMA at 1-800-621-8335. The monetary values for the codes will be published in the 2006 Medicare fee schedule, due out in November 2005. APApractice.org will provide more information as it becomes available.
Q: Is there a grace period during which I may continue using the old codes?
A: No. Practitioners must use the existing testing codes through Dec. 31, 2005, and begin using the revised codes starting Jan. 1, 2006. Psychologists, their office staffs and their billing agents should be prepared in advance to make the switch to the revised codes on Jan. 1.
Q: How should I handle billing under the revised codes?
A: Billing under the revised codes will be based on who administers a test and how long it takes. Testing conducted by a psychologist is billed in hourly units, based on the number of hours the psychologist spends administering a test and interpreting and reporting test results. Testing conducted by a technician is based on the number of hours the technician spends administering a test. Testing conducted by computer is billed at a flat rate using a single code. When billing the revised codes, it is important to note in the client’s record who administered the test and for how long.
The following scenarios offer examples for how to bill under the revised codes:
Billing example #1: If a psychologist conducts five hours of psychological or neuropsychological testing and three hours of interpreting and reporting the test results, he or she would bill for eight units of the psychologist-based code.
Billing example #2: If a technician conducts two hours of testing and a psychologist conducts 3.5 hours of testing and 2.5 hours of interpretation and reporting, he or she would bill for two units of the technician-based code and six units of the psychologist-based code.
Billing example #3: If a patient completes two hours of computerized testing and a psychologist conducts two hours of testing and one hour of interpretation and reporting, he or she would bill for the computer-based code (which is a single, flat-payment rate that is not measured in units) and three units of the psychologist-based code.
Q: What type of testing work by a technician is billable under the new technician-based codes?
A: The time a technician is with the patient, administering tests, or supervising the patient as he or she completes the tests, is considered billable under the technician-based code. The technician must be with the patient, face-to-face, during the testing in order for the psychologist to be able to bill for the time.
Q: Where can I get help with questions about or billing problems related to the revised codes?
A: Anyone with questions or billing problems should call the Practice Directorate’s government relations department at (202) 336-5889 or email pracgovt@apa.org.
APApractice.org will provide additional information about the revised CPT testing codes as it becomes available.
Current Procedural Terminology© 2005 American Medical Association. All Rights Reserved.