Psychological and Neuropsychological Tests Provider Types Affected Provider Action Needed What You Need to Know What You Need to Do Background The CPT codes for these tests are included in the range of codes from 96101 to 96120. The appropriate codes when billing for psychological tests are: 96101, 96102, 96103, 96105, 96110, and 96111; and when billing for neuropsychological tests are: 96116, 96118, 96119, and 96120. All of the tests under this CPT code range 96101-96120 are covered and indicated as active codes under the MPFS database. More specifically, CR 5204, from which this article is taken, provides that (effective January 1, 2006) the CPT codes for psychological and neuropsychological tests include tests performed by technicians and computers (CPT codes 96102, 96103, 96119 and 96120) in addition to tests performed by physicians, clinical psychologists, independently practicing psychologists and other qualified nonphysician practitioners. These changes, made in accordance with the final physician fee schedule regulation, were published in the Federal Register on November 21, 2005, at 70 FR 70279 and 70280 under Table 29 (AMA, Relative Value Scale Update Committee (RUC) and Health Care Professional Advisory Committee (HCPAC) Recommendations and CMS Decisions for New and Revised 2006 CPT Codes). You should be aware of some supervision requirements for diagnostic psychological and neuropsychological tests. First, under the diagnostic tests provision, all diagnostic tests are assigned a certain level of supervision. Generally, regulations governing the diagnostic tests provision allow only physicians to provide the assigned level of supervision for such tests; however, for diagnostic psychological and neuropsychological tests, there is a regulatory exception that allows either a clinical psychologist (CP) or a physician to perform the assigned general supervision. Moreover, nonphysician practitioners such as nurse practitioners (NPs), clinical nurse specialists (CNS), and physician assistants (PA), who personally perform diagnostic psychological and neuropsychological tests are excluded from having to perform these tests under the supervision requirements of the diagnostic psychological and neuropsychological tests benefit, that is, under the general supervision of a physician or a CP. In fact, rather than providing them under the requirements for diagnostic psychological and neuropsychological tests, NPs and CNSs must perform such tests under the requirements of their respective benefit. Therefore, NPs and CNSs must perform them in collaboration (as defined under Medicare law at section 1861(aa)(6) of the Act) with a physician. Likewise, PAs must perform these tests under the general supervision of a physician as required for services furnished under the PA benefit. To continue, physical therapists (PT), occupational therapists (OT) and speech language pathologists (SLP) are authorized to bill three test codes (96105, 96110, and 96111) as “sometimes therapy” codes. However, when PTs, OTs, and SLPs perform these three tests, they must do so under the general supervision of a physician or a CP. You should also note that expenses for diagnostic psychological and neuropsychological tests are not subject to the outpatient mental health treatment limitation, which is the payment limitation on treatment services for mental, psychoneurotic and personality disorders as authorized under Section 1833(c) of the Social Security Act. Further, the payment amounts that are billed for tests performed by a technician or a computer reflect a site of service payment differential for the facility and non-facility settings. Remember that CPs, NPs, CNSs, and PAs are required by law to accept assigned payment for psychological and neuropsychological tests. And although Independently Practicing Psychologists (IPP) are not required to accept assigned payment for these tests, they must report the name and address of the physician who ordered the test on the claim form when billing for tests. (An IPP is any psychologist who is licensed (or certified) to practice psychology in the state or jurisdiction where furnishing services or, if the jurisdiction does not issue licenses, if provided by any practicing psychologist. Examples of psychologists (other than CPs) whose psychological and neuropsychological tests are covered under the diagnostic tests provision include, but are not limited to, educational psychologists and counseling psychologists.) Additionally, there is no authorization under Medicare law for payment for diagnostic tests when performed on an “incident to” basis. Following is a summary of who may bill for diagnostic psychological and neuropsychological tests, and references for the review of qualifications, when appropriate. Providers that May Bill for Diagnostic Psychological and Neuropsychological Tests
The Medicare Benefits Policy Manual is available at http://www.cms.hhs.gov/Manuals/IOM/list.asp#TopOfPage Here are some other important things that you should know.
Additional Information If you have any questions, please contact your carrier or fiscal intermediary at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip Disclaimer MLN Matters Number: MM5204 |
on the CMS Web site. 
on the CMS Web site. As an attachment to this CR, you will find updated relevant portions of Publication 100.02 (Medicare Benefit Policy Manual), Chapter 15 (Covered Medical and Other Health Services), Section 80.2 (Psychological Tests and Neuropsychological Tests). 
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