In recent years, the Centers for Medicare & Medicaid Services (CMS) have introduced significant updates to the billing codes for psychological testing and evaluation.
These changes aim to better align billing practices with the evolving needs of healthcare organizations and their patients.
Specifically, in 2019, CMS retired these CPT codes for mental health; CPT 96103 and CPT 96101, replacing them with CPT 96130, CPT 96138, CPT 96146, and 96136 CPT codes.
This means that the latest move made by the CMS will hopefully improve the financial feasibility of testing and treating mental health in the practical setting where instead of just screening there can be ancillary care.
Screening for Mental Health Conditions
Screening is an essential first step in identifying mental health conditions among large populations. It involves the systematic use of tools to detect potential symptoms in individuals who may appear otherwise healthy.
Screening can occur during routine exams, in waiting rooms using digital tools, or through paper-based instruments.
96127 CPT Code
CPT 96127 is used for brief emotional or behavioral assessments with standardized instruments, including scoring and documentation. Common tools include the PHQ-9 or GAD-7. Screening is an efficient way to flag patients who may require further testing or interventions.
A Closer Look at Test Administration
Once screening indicates a potential issue or a comorbid condition exists, test administration can determine the presence or absence of specific mental health conditions.
Billing for test administration requires medical necessity, supported by an appropriate ICD-10 diagnosis code. Testing can be conducted by a physician, technician, or computer.
96136 CPT Code
This code applies when a physician or qualified healthcare professional administers and scores at least two tests. These can be paper-based, verbal, or electronic.
- Definition: “Psychological or neuropsychological test administration/scoring by physician or other qualified healthcare professional, two or more tests, any method; first 30 minutes.”
- Additional Billing: Use CPT 96137 for each additional 30-minute increment.
96138 CPT Code
CPT 96138 is similar to the 96136 CPT code but is used when tests are administered by a technician under supervision.
- Definition: “Psychological or neuropsychological test administration/scoring by a technician, two or more tests, any method; first 30 minutes.”
- Additional Billing: Use CPT 96139 for each additional 30-minute increment.
96146 CPT Code
This code applies to computerized test administration and scoring using a single automated instrument.
- Definition: “Psychological or neuropsychological test administration, with a single automated instrument via an electronic platform, with the automated result only.”
- Application: Commonly used for tests like digital cognitive assessments or mood screening tools.
Test Evaluation Services
After tests are administered, evaluation services allow qualified professionals to analyze results and develop a treatment plan.
96130 CPT Code
This code covers the integration and interpretation of test results, clinical decision-making, treatment planning, and interactive feedback with the patient or their caregivers.
- Definition: “Psychological testing evaluation services by physician or other qualified healthcare professional, including integration of patient data, interpretation of standardized test results, clinical data, treatment planning, and report writing; first hour.”
- Additional Billing: Use CPT 96131 for each additional hour.
Important Updates to Psychological Testing Codes
CMS regularly updates guidelines to ensure they align with current practices and technologies. Below are some critical updates:
As of July 1, 2020
Testing that uses only brief symptom inventories or screening tests (e.g., PHQ-9, GAD-7) does not qualify as comprehensive psychological testing. These tests should be billed using CPT 96127 or CPT 96146.
Telemedicine Billing
Under the existing rules, invoices for CPT 96130, CPT 96136, and CPT 96138, which include audio-only discussions, are permissible. This will continue to hold up through future years, highlighting CMS’ recognition of telehealth’s growing impact on mental well-being.
Having Trouble with Billing for 96136 CPT Code?
Working with intricate CPT codes, such as the 96136 CPT code, demonstrates how crucial correct billing is for psychological testing services. Properly managing this code will make certain that your clinic garners the reimbursement deserved and continues to offer thorough mental health care.
MCB specializes in handling billing for psychological testing, so you can focus on what matters most, and that is your patients.
For more detailed information on billing for psychological testing, contact our team or explore additional resources tailored to your practice.
