2019 Psychological Testing Codes

April 11, 2019

Perspective by Ann Richmond

 

As most psychologists and some psychiatrists know by now CPT coding has changed for psychological testing as of 1/1/19.  Instead of one code for psychological testing there are now four.  Instead of two codes for neuropsychological testing there are now four.

Essentially the codes are now broken down into subcategories.

Administration and Scoring of psychological tests or neuropsychological tests are now one set of codes (96136 and 96137) while Interpretation and Integration of the findings is another set of codes 96130 and 96131 or 96132 and 96133.

I believe the thought by creators of the codes was that the administering and scoring of tests is a less complex process and should be paid less for this part of the testing process. Indeed codes for administration and scoring 96136 and 96137 are paid less by the hour and in fact these codes are broken down into ½ hour units (.5 hour).  The first .5 hour for this service by a “professional” is coded with 96136 and only one unit may be billed for this code on one day.  Any additional .5 hours for this service are coded with 96137 and multiple units are allowed for this code.  Maximum of 6 hours is allowed for this code on any one day. Six hours would be one unit of 96136 and 11 units of 96137.

Now if you have a “technician” (not defined) doing the work of administering and scoring, their work must be coded with a different set of codes which are paid at a more reduced rate. Those codes are 96138 for first .5 hour and 96139 for any additional .5 hours.  The same rules apply to these codes in regards to maximum per day.

Administration and scoring codes are the same for psychological or neuropsychological testing.

Then, we have the more complex processes of testing which require a professional and are paid at a higher rate per hour. The service is defined as “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 members or caregivers when preformed.”

Codes are broken down into neuropsychological and psychological.  These codes are one hour units. Again, the first hour is coded by one code (1 unit allowed only) and any additional hours are coded with another code which allows multiple units.

For regular psychological testing the first hour of the professional component are billed with 96130 (one unit allowed). For additional hours code 96131 is used.

For Neuropsychological testing the first hour of the professional component is billed with 96132 (one unit allowed).  For additional hours code used is 96133 is used.

The professional component codes allow up to 8 hours a day.

Additional confines:

If testing is billed on same day as any E&M code (face to face office visit or record review) a modifier must be used to signify that the testing was a separately identifiable procedure.  As well if testing is done on the same day as psychotherapy a modifier must be used to signify that it was a separate service.

CODEDESCRIPTIONUnitCurrent Fee
96136First 1/2 hour of administration and scoring of psychological tests by Pro.5 hrs64.95
96137Additional 1/2 hours of administration and scoring of tests by Pro.5 hrs60.47
96138First 1/2 hour of administration and scoring of psychological tests by Tech.5 hrs55.01
96139Additional 1/2 hours of administration and scoring of tests by Tech.5 hrs55.01
96130First hour of interpretation and integration of psychological tests by Pro1 hr155.44
96131Additional hours of interpretation and integration of psychological tests by Pro1 hr118.32
96132First hour of interpretation and integration of Neuropsychological tests by Pro1 hr176.67
96133Additional hours of interpretation and integration of Neuropsychological tests by Pro1 hr134.70

 

More to come….

Examples of language in reports required.