CMS Doubled the Billing Codes for Psychological Testing: How to Navigate Them
It’s been almost a year since CMS rolled out new requirements for billing psychological testing services. Before there were only two CPT codes you could use: 96101 per hour with a psychologist or 96102 per hour of a technician’s time. It was the same for Neuropsychological Testing with CPT codes 96119 and 96116.
In 2018, after the Centers for Medicare and Medicaid Services created a more detailed way to bill for psychological testing services, those four codes doubled to eight!
Since things are more complicated now, here’s a quick take on how to bill with these codes.
Codes for Test Evaluation vs. Test Administration and Scoring
“Psychological Testing” has been separated into two distinct parts:
- Test Evaluation Services – which can only be done by a psychologist or other qualified healthcare professional.
- Test Administration and Scoring – which can be done by a psychologist (or similar) or a Technician.
When it comes to billing, it’s easiest to break these down into roles and minutes.
Psychological Testing Evaluation Services
At a mental health clinic this must be done by a Psychologist. For Psychological Testing Evaluation Services the math can get a bit difficult because there is a minimum 31-minute time requirement before a code “counts.”
For example if you’re billing…
- 90 minutes or less of Evaluation – Bill one unit of CPT code 96130
- 91 – 150 minutes of Evaluation – Bill one unit of 96130 and one unit of 96131
First Hour + the minimum 31-60 min for the next hour to “count.” - 151 – 210 minutes of evaluation – Bill one unit of 96130 and two units of 96131
120 min + the minimum 31 min to count as an hour.
Test Administration and Scoring
Test Administration and Scoring work the same way, but in 30-minute increments and 16-minute minimums.
If a Psychologist (or similar) does the Test Administration and scoring, then use 96136 CPT code for the first 30 min and 96137 CPT code for additional 30 minutes.
If a Psychologist spends…
- 45 minutes or less of Admin/Scoring – Bill one unit of 96136
- 46 – 75 minutes of Admin/Scoring – Bill one unit of 96136 and one unit of 96137
- 76 – 105 minutes of Admin/Scoring – Bill one unit of 96136 and two units of 96137
- 106 – 135 minutes of Admin/Scoring – Bill one unit of 96136 and three units of 96137
If you have a Technician on staff for Test Administration and Scoring it’s the same process with different CPT codes. Use a 96138 CPT code for the first 30 minutes and 96139 CPT Code for each additional 30 minutes.
So if a Technician spends…
- 45 minutes or less of Tech Admin/Scoring – Bill one unit of 96138
- 46 – 75 minutes of Tech Admin/Scoring – Bill one unit of 96138 and one unit of 96139
- 76 – 105 minutes of Tech Admin/Scoring – Bill one unit of 96138 and two units of 96139
- 106 – 135 minutes of Tech Admin/Scoring – Bill one unit of 96138 and three units of 96139
That’s it! Those are the basics.
For more details on Psychological Testing you can find APA’s explanation of the new CPT codes here. Neuropsychological Testing is the exact same, but the codes are different.
APA released a full guide in 2019 here if you want to dig into specific examples and more detail.
A bit more complication for more accuracy
While these codes do make it more difficult to bill for psychological testing; with greater complexity comes greater accuracy.
Thankfully, we at BreezyNotes EHR are used to taking the complexity out of mental health. And with BreezyBilling©, our team of mental health billing professionals will make sure your Psychological Testing and Neuropsychological Testing claims will be processed by insurance and get billed correctly. We’ll follow up on any denials or rejections, too.
Contact us below to learn more about how we can help your practice’s billing and revenue cycle management, or click here for more details.