Getting reimbursed: Continued preparation for January's testing code changes - APA Services, Inc.
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Getting reimbursed:
Continued
preparation for
January’s testing
code changes
Presented December 5, 2018 by
Antonio E. Puente, PhD
Neil H. Pliskin, PhD
Diane Pedulla, JD
©2018 APA Practice Organization
CPT Copyright 2017 American Medical Association. All rights reserved.
CPT® is a registered trademark of the American Medical Association.
Objectives
Review the new testing codes and definitions
Walk through how to crosswalk from the old codes to the new
ones
Introduce the new RVUs and payment structure
Apply the new codes using practical examples
Discuss how to document your work
Address “frequently asked questions”
2
©2018 APA Practice Organization Promoting and supporting practicing psychologists
New Testing Code Structure:
Base Code for Testing Evaluation Services
Preservice Intraservice Postservice
Work Work Work
Preliminary Test Selection Interpretation of Tests Transcription of Report
Record Review Integration Report Distribution
Call to ascertain referral Q Clinical Decision Making Arrangement of Referrals
Diagnosis and Tx Planning
Creation of Report
Interactive Feedback
3
©2018 APA Practice Organization Promoting and supporting practicing psychologists
New Testing Code Structure
BASE CODE Preservice Intraservice Postservice
(Used Once) Work Work Work
ADD-ON CODE Preservice Intraservice
Postservice
(Possibly used Work Work
Work
multiple times)
4
©2018 APA Practice Organization Promoting and supporting practicing psychologistsNew Testing Code Family
Thirteen new CPT codes that describe developmental/behavioral screening and testing services and psychological & neuropsychological testing services.
5Psychological Testing Services
10
6
Promoting and supporting practicing psychologistsPsychiatric Diagnostic Evaluation
90791 Psychiatric diagnostic evaluation
Please note that no changes have been made to CPT® code 90791.
This service includes a comprehensive diagnostic evaluation of psychological
and psychosocial conditions and is performed prior to psychological evaluation
and test administration and scoring services.
7
©2018 APA Practice Organization Promoting and supporting practicing psychologistsExisting vs. 2019 Psychological Testing Codes
90791 96101 96102
Psychiatric
Psychological testing per hour Psychological testing
Diagnostic Evaluation
psychologist's or physician’s time per hour technician time
90791 96136 96130 96138
Psychiatric Psychological or Psychological
Diagnostic Neuropsychological Test Testing Evaluation, Psychological or Neuropsychological
Evaluation Admin/Data Gathering first hour Test Admin/Data Gathering by
by Physician or other Technician, first 30 mins
No Change for 2019 QHP, first 30 minutes
+ 96137 + 96131
Psychological or Psychological + 96139
Neuropsychological Test Testing Evaluation, Psychological or Neuropsychological
Admin/Data Gathering by each addt’l hour Test Admin/Data Gathering by
Physician or other QHP, Technician, each addt’l 30 mins
each addt’l 30 minutes
CPT Copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the AMA. 8
©2018 APA Practice Organization Promoting and supporting practicing psychologistsPsychological Testing Evaluation Services
96130 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
member(s) or caregiver(s), when performed; first hour
✚96131 each additional hour (List separately in addition to code
for primary procedure)
9
©2018 APA Practice Organization Promoting and supporting practicing psychologistsTest Administration & Scoring
By Qualified Healthcare Professional
96136 Psychological or neuropsychological test administration
and scoring by physician or other qualified health care
professional, two or more tests, any method, first 30
minutes
✚96137 each additional 30 minutes (List separately in
addition to code for primary procedure)
10
©2018 APA Practice Organization Promoting and supporting practicing psychologistsPsychological Testing Psychological Testing Evaluation Services
By Psychologist or Physician By Professional
2018 2019
2018 CPT® Descriptor 2019 CPT® Descriptor
CPT® Code CPT® Code
Psychological testing evaluation services by
physician or other qualified health care
professional, including integration of
Psychological patient data, interpretation of
Testing and 96130* standardized test results and clinical data,
clinical decision making, treatment
Scoring & planning and report and interactive
Psychological testing (includes
Evaluation psychodiagnostic assessment of feedback to the patient, family member(s)
BY emotionality, intellectual abilities, or caregiver(s), when performed; first hour
PROFESSIONAL personality and psychopathology, e.g.,
Crosswalk 96101
MMPI, Rorschach, WAIS), per hour of each additional hour (List separately in
the psychologist's or physician's time, 96131* addition to code for primary procedure)
both face-to-face time administering
tests to the patient and time Test Administration and Scoring
interpreting these test results and By Professional
preparing the report Psychological or neuropsychological test
administration and scoring by physician or
96136** other qualified health care professional,
two or more tests, any method, first 30
minutes
each additional 30 minutes (List separately
96137**
in addition to code for primary procedure)
11
©2018 APA Practice Organization Promoting and supporting practicing psychologistsPsychological Testing and Scoring
By Technician
96138 Psychological or neuropsychological test administration
and scoring by technician, two or more tests, any
method; first 30 minutes
✚96139 each additional 30 minutes (List separately in
addition to code for primary procedure)
12
©2018 APA Practice Organization Promoting and supporting practicing psychologistsPsychological Testing Psychological Testing Evaluation Services
By Psychologist or Physician By Professional
2018 2019
2018 CPT® Descriptor 2019 CPT® Descriptor
CPT® Code CPT® Code
Psychological testing evaluation services by
physician or other qualified health care
professional, including integration of patient
data, interpretation of standardized test
Psychological 96130* results and clinical data, clinical decision
making, treatment planning and report and
Testing and interactive feedback to the patient, family
Psychological testing (includes
Scoring By psychodiagnostic assessment of member(s) or caregiver(s), when performed;
Technician emotionality, intellectual abilities, first hour
& Evaluation personality and psychopathology, e.g.,
By Professional 96101
MMPI, Rorschach, WAIS), per hour of 96131*
each additional hour (List separately in
the psychologist's or physician's time, addition to code for primary procedure)
Crosswalk both face-to-face time administering
Test Administration and Scoring
tests to the patient and time
interpreting these test results and By Technician
preparing the report
Psychological or neuropsychological test
96138 administration and scoring by technician, two
or more tests, any method; first 30 minutes
each additional 30 minutes (List separately in
96139
addition to code for primary procedure)
13
©2018 APA Practice Organization Promoting and supporting practicing psychologistsNeuropsychological Testing Services
20
14
©2018 APA Practice Organization Promoting and supporting practicing psychologistsNeurobehavioral Status Exam
96116 Neurobehavioral status exam (clinical assessment of thinking,
reasoning and judgement, e.g., acquired knowledge, attention,
language, memory, planning and problem solving, and visual
spatial abilities), by physician or other qualified health care
professional, both face-to-face time with the patient and time
interpreting test results and preparing the report; first hour
✚96121 each additional hour (List separately in addition to code for
primary procedure)
15
©2018 APA Practice Organization Promoting and supporting practicing psychologistsNeurobehavioral Status Exam
2018
2019
CPT® 2018 CPT® Descriptor 2019 CPT® Descriptor
CPT® Code
Code
Neurobehavioral status exam (clinical
assessment of thinking, reasoning and
Neurobehavioral status exam judgement, e.g., acquired knowledge,
(clinical assessment of thinking, attention, language, memory, planning and
reasoning and judgment, e.g., 96116 problem solving, and visual spatial abilities),
acquired knowledge, attention, by physician or other qualified health care
language, memory, planning and professional, both face-to-face time with the
96116 problem solving, and visual spatial patient and time interpreting test results
abilities), per hour of the and preparing the report; first hour
psychologist's or physician's time,
both face-to-face time with the
patient and time interpreting test
results and preparing the report
each additional hour (List separately in
96121
addition to code for primary procedure)
16
©2018 APA Practice Organization Promoting and supporting practicing psychologistsExisting vs. 2019 Neuropsychological Testing Codes
96116 96118 96119
Neurobehavioral Neuropsychological testing Neuropsychological testing
Status Exam per hour psychologist's or per hour
physician's time technician time
96116 96136 96132 96138
Neurobehavioral Psychological or Neuropsychological Neuropsychological Psychological or
Status Exam per hour Test Admin/Data Gathering by Physician Testing Evaluation, Neuropsychological Test
physician or other or other QHP, first 30 minutes first hour Admin/Data Gathering
QHP’s time by Technician, first 30 mins
+ 96121 + 96137 + 96133
Neurobehavioral Psychological or Neuropsychological Neuropsychological + 96139
Status Exam each Test Admin/Data Gathering by Physician Testing Evaluation, Psychological or Neuropsychological
addt’l hour physician or other QHP, each addt’l 30 minutes each addt’l hour Test Admin/Data Gathering by
or other QHP’s time Technician, each addt’l 30 mins
CPT Copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the AMA. 17
©2018 APA Practice Organization Promoting and supporting practicing psychologistsNeuropsychological Testing Evaluation Services
96132 Neuropsychological 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 member(s)
or caregiver(s), when performed; first hour
✚96133 each additional hour (List separately in addition to code for
primary procedure)
18
©2018 APA Practice Organization Promoting and supporting practicing psychologistsTest Administration & Scoring
By Qualified Healthcare Professional
(e.g. clinical neuropsychologist)
96136 Psychological or neuropsychological test administration
and scoring by physician or other qualified health care
professional, two or more tests, any method, first 30
minutes
✚96137 each additional 30 minutes (List separately in
addition to code for primary procedure)
19
©2018 APA Practice Organization Promoting and supporting practicing psychologistsNeuropsychological Testing Neuropsychological Testing Evaluation Services
Neuropsychological By Psychologist or Physician By Professional
Testing and Scoring & 2018
2019
CPT® 2018 CPT® Descriptor 2019 CPT® Descriptor
Evaluation Services Code
CPT® Code
by Professional Neuropsychological testing evaluation
Crosswalk services by physician or other qualified
health care professional, including
integration of patient data, interpretation
96132* of standardized test results and clinical
data, clinical decision making, treatment
Neuropsychological testing planning and report and interactive
(eg, Halstead-Reitan feedback to the patient, family member(s)
Neuropsychological Battery, or caregiver(s), when performed; first hour
Wechsler Memory Scales and
Wisconsin Card Sorting Test), each additional hour (List
96118 per hour of the psychologist's 96133* separately in addition to code
or physician's time, both face- for primary procedure)
to-face time administering Test Administration and Scoring
tests to the patient and time By Professional
interpreting these test results
and preparing the report Psychological or neuropsychological test
administration and scoring by physician or
96136** other qualified health care professional,
two or more tests, any method, first 30
minutes
each additional 30 minutes (List
96137** separately in addition to code
for primary procedure)
20
©2018 APA Practice Organization Promoting and supporting practicing psychologistsNeuropsychological Testing & Scoring
By Technician
96138 Psychological or neuropsychological test administration
and scoring by technician, two or more tests, any
method; first 30 minutes
✚96139 each additional 30 minutes (List separately in
addition to code for primary procedure)
21
©2018 APA Practice Organization Promoting and supporting practicing psychologistsTechnician Administered Neuropsychological Testing Evaluation Services
Neuropsychological Testing By Professional
2018
2019
Neuropsychological CPT® 2018 CPT® Descriptor
CPT® Code
2019 CPT® Descriptor
Code
Testing and Scoring
by Technician & Neuropsychological testing evaluation services
Evaluation Services by physician or other qualified health care
professional, including integration of patient
by Professional 96132*
data, interpretation of standardized test results
and clinical data, clinical decision making,
Crosswalk treatment planning and report and interactive
feedback to the patient, family member(s) or
Neuropsychological testing caregiver(s), when performed; first hour
(e.g., Halstead-Reitan
Neuropsychological Battery,
Wechsler Memory Scales and each additional hour (List
Wisconsin Card Sorting Test), 96133* separately in addition to code for
96119
with qualified health care primary procedure)
professional interpretation
and report, administered by Test Administration and Scoring
technician, per hour of by Technician
technician time, face-to-face
Psychological or neuropsychological test
96138** administration and scoring by technician, two
or more tests, any method; first 30 minutes
each additional 30 minutes (List
96139** separately in addition to code for
primary procedure)
22
©2018 APA Practice Organization Promoting and supporting practicing psychologistsCPT Time Rule
For time-based codes, the CPT code set states that the following standards shall apply to
time measurement:
A unit of time is attained when the mid-point is passed.
This means:
A minimum of 16 minutes & maximum of 30 minutes must be provided for 30-minute codes
(Two 30-minute units can be billed when 46-60 minutes of service is provided)
A minimum of 31 minutes & maximum of 60 minutes must be provided for 60-minute codes
(Two 60-minute units can be billed when 91-120 minutes of service is provided)
23
©2018 APA Practice Organization Promoting and supporting practicing psychologistsCPT Time Rule – Example
When performing a neurobehavioral exam, the first hour of service is
billed with CPT® code 96116.
However, if the service is not complete in one hour, the first unit of
the add-on code 96121 may be used if the neuropsychologist
performs at least an additional 31 minutes of work.
These rules apply to all time-based codes in the new code set;
however, it is important to pay close attention to the units of time stated in each code descriptor as they vary from 30
minutes to 1 hour.
24
©2018 APA Practice Organization Promoting and supporting practicing psychologistsSingle Psychological or Neuropsychological
Automated Testing & Result
34
25
©2018 APA Practice Organization Promoting and supporting practicing psychologistsExisting vs. 2019 Automated Test via
Electronic Platform
96103 96120
Psychological Neuropsychological
testing testing
administered administered
by computer by computer
96146
Psychological or
Neuropsychological Test Admin,
Single Automated Instrument
26
©2018 APA Practice Organization Promoting and supporting practicing psychologistsAutomated Testing and Result
96146 Psychological or neuropsychological test
administration, with single automated instrument
via electronic platform, with automated result only
27
©2018 APA Practice Organization Promoting and supporting practicing psychologistsCrosswalk for 2019 Computerized Test CPT® Codes
Psychological & Neuropsychological Testing Single Psychological or Neuropsychological
By Computer Automated Test with Automated Result
2018 2019
2018 CPT® Descriptor 2019 CPT® Descriptor
CPT® Code CPT® Code
Psychological testing (includes
psychodiagnostic assessment of
emotionality, intellectual abilities,
96103 personality and psychopathology, e.g.,
MMPI), administered by a computer, with Psychological or neuropsychological test
qualified health care professional administration, with single automated
interpretation and report 96146
instrument via electronic platform, with
automated result only
Neuropsychological testing (e.g., Wisconsin
Card Sorting Test), administered by a
96120
computer, with qualified health care
professional interpretation and report
28
©2018 APA Practice Organization Promoting and supporting practicing psychologistsClinical Decision Making
29
©2018 APA Practice Organization Promoting and supporting practicing psychologistsClinical Decision Making = Cognitive Work
Physicians highly attuned to capturing and quantifying the cognitive work
that goes into medical and clinical decision making
This is work we take for granted but occurs throughout the evaluation
process.
The ability to accurately and appropriately document our cognitive work
will be important for psychologists in the new testing code structure
30
©2018 APA Practice Organization Promoting and supporting practicing psychologistsThe Psychologist Engages in Clinical Decision Making
The psychologist determines how the patient is responding throughout the
psychological and neuropsychological testing process.
Examples of intra-session clinical decision making:
Level of functioning
Level of impairment
Nature of symptoms
Emotional/behavioral response
Level of literacy
Level of language proficiency and/or acculturation
Isn’t providing valid data
Requires higher level or more nuanced tests for accurate diagnosis
**This Is especially important to document when using technicians**
31
©2018 APA Practice Organization Promoting and supporting practicing psychologistsDocumenting Your Work
32
©2018 APA Practice Organization Promoting and supporting practicing psychologistsCoding and Documentation
It is recommended that Testing Evaluation Services (96130-96133) and Test
Administration and Scoring services (96136-96139) be documented in a
table within the report.
We suggest listing dates and total times for each activity (including
scoring and clinical decision making), as well as a separate log sheet
detailing start/stop times in the clinical chart.
33
©2018 APA Practice Organization Promoting and supporting practicing psychologistsCoding and Documentation
When a service is spread out over multiple visits, it is recommended that
all codes be listed by date/service and billed together on the last date of
service when the evaluation process is completed.
A base code should only be submitted for the first unit of service of the
evaluation process, and only add-on codes be used to capture the
services provided during subsequent days of service.
Bill separate interactive feedback session using an add-on code (either
96131 or 96133)
34
©2018 APA Practice Organization Promoting and supporting practicing psychologistsOne Way to Document Clinical Decision Making
Professional Psychological/Neuropsychological
Start Time Stop Time Total Units
Testing Evaluation Services
Intra-Session Clinical Decision Making-
referral review/test selection:
tech consult/test review/modification:
tech consult/test review/modification:
patient limitation management:
patient behavior management:
patient symptom monitoring:
Face-to-Face Interpretive Feedback:
Record Review/Integration/Report
Generation:
35
©2018 APA Practice Organization Promoting and supporting practicing psychologistsTransparency and comprehensiveness in
documentation is the key!
36
©2018 APA Practice Organization Promoting and supporting practicing psychologists2019 Non-Facility RVUs and Payment Structure
37
©2018 APA Practice Organization Promoting and supporting practicing psychologistsThree (3) Components of a Total Relative Value Unit
(RVU)
Total RVU = Cognitive Work RVU + Practice Expense
RVU + Professional Liability Insurance RVU
The Total RVUs are then multiplied by a geographic price index.
38
©2018 APA Practice Organization Promoting and supporting practicing psychologists2019 Psychological and Neuropsychological Testing CPT® Codes & Total RVUs
CPT Code RVUs
Neurobehavioral Status Exam
96116 First Hour 2.70
✚96121 Each additional hour 2.32
Test Evaluation Services
96130:
Psychological Testing First hour 3.30
Evaluation Services
✚96131 Each additional hour 2.51
96132:
Neuropsychological
First hour 3.71
testing evaluation
services
✚96133 Each additional hour 2.83
39
©2018 APA Practice Organization Promoting and supporting practicing psychologists2019 Psychological & Neuropsychological Testing CPT® Codes & Total RVUs,
cont.
CPT Code RVUs
Test Administration and Scoring
By Professional
96136 First 30 minutes 1.33
✚96137 Each additional 30 minutes 1.23
By Technician
96138 First 30 minutes 1.08
✚96139 Each additional 30 minute 1.08
Automated Testing and Result
Single automated instrument
96146 via electronic platform, with 0.06
automated result only
40
Promoting and supporting practicing psychologistsHow to Use the 2019 Non-Facility RVUs
The Conversion Factor will vary by geographic location.
2019 Conversion Factor is approximately $36.0391.
To determine the specific dollar amount per unit of a particular
code, multiply the Total Non-Facility RVU value by the
Conversion Factor.
Ex. for 1 hour of 96116, 2.70 x $36.0391 = $97.31.
41
©2018 APA Practice Organization Promoting and supporting practicing psychologistsA note about Medicare’s Facility Fee Reduction
As part of a trend since 2015, CMS is reducing valuations for facility-based
services, especially in hospitals, across all disciplines. This decision is
unrelated to APA’s CPT/RUC effort and it is not meant to target
psychological/neuropsychological testing services.
Since many psychologists and technicians are salaried employees at
hospitals and facilities, this is not a direct payment reduction. Rather, it’s a
reduction to the fees paid directly to the facilities to cover overhead
charges and administrative costs.
If this situation applies to you and you’d like additional information, please
contact the APA Practice Organization.
42
©2018 APA Practice Organization Promoting and supporting practicing psychologistsApplying the New Codes Using Practical
Examples
43
©2018 APA Practice Organization Promoting and supporting practicing psychologistsClinical Example 1:
Pediatric ADHD Assessment
Psychiatric Diagnostic Interview + 3 hours of psychologist testing + 3 hours of professional evaluation
services
Code Units RVU
Diagnostic Interview 90791 (1 unit@ 3.89) 3.89
Test Administration/Data Gathering By Psychologist
First 30 minutes 96136 (Base Code; 1 unit@ 1.33) 1.33
Each additional 30 min 96137 (Add-on; 5 units@ 1.23) 6.15
Psychological Testing Evaluation (Professional) Services
Hour 1 96130 (Base Code ; 1 unit@ 3.30) 3.30
Hours 2 & 3 96131 (Add-on; 2 units@ 2.51) 5.02
Total RVUs 19.69
CPT Copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the AMA. 44
©2018 APA Practice Organization Promoting and supporting practicing psychologistsClinical Example 2:
Adult with major depression and psychotic features
Diagnostic Interview + 3 hours of technician testing + 3 hours of professional evaluation services
Code RVU
Diagnostic Interview 90791 (1 unit@3.89) 3.89
Test Administration/Data Gathering by Technician
First 30 minutes 96138 (Base Code; 1 unit@ 1.08) 1.08
Each additional 30 min 96139 (Add-on; 5 units@ 1.08) 5.40
Psychological Testing Evaluation (Professional) Services
Hour 1 96130 (Base Code ; 1 unit@ 3.30) 3.30
Hours 2 & 3 96131 (Add-on; 2 units@ 2.51) 5.02
Total RVUs 18.69
CPT Copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the AMA. 45
©2018 APA Practice Organization Promoting and supporting practicing psychologistsClinical Example 3:
MDD+ Psychosis Evaluation with Combined QHP and Technician-Administered
Assessment: Diagnostic Interview+ 2 hours of technician testing + 2 hours of psychologist
administered testing + 2 hours of professional evaluation services
Code RVU
Diagnostic Interview 90791 (1 unit@ 3.89) 3.89
Test Administration/Data Gathering Psychologist
First 30 minutes 96136 (Base Code; 1 unit@ 1.33) 1.33
Each additional 30 minutes 96137 (Add-on; 3 units@ 1.23) 3.69
Testing Administration/Data Gathering By Technician
First 30 minutes 96138 (Base Code; 1 unit@1.08) 1.08
Each additional 30 minutes 96139 (Add-on; 3 units@1.08) 3.24
Testing Evaluation Services By QHP
Hour 1 96130 (Base Code ; 1 unit@ 3.30) 3.30
Hour 2 96131 (Add-on ; 1 unit@2.51) 2.51
Total RVUs 19.04
46
CPT Copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the AMA.
©2018 APA Practice Organization Promoting and supporting practicing psychologistsClinical Example 4:
Differential Diagnosis of Memory Loss/Early Alzheimer’s Disease
2 hours NSE + 4 hours of neuropsychologist testing + 2 hours of professional evaluation services
Code RVU
Clinical Interview/Neurobehavioral Status Examination (NSE)
Hour 1 96116 (Base Code; 1 unit@ 2.70) 2.70
Each additional hour 96121 (Add-on; 1 unit@ 2.32) 2.32
Test Administration/Data Gathering Psychologist
First 30 minutes 96136(Base Code; 1 unit@ 1.33) 1.33
Each additional 30 min 96137 (Add-on; 7 units@ 1.23) 8.61
Neuropsychological Testing Evaluation (Professional) Services
Hour 1 96132 (Base Code; 1 unit@ 3.71) 3.71
Hour 2 96133 (Add-on; 1 unit@ 2.83) 2.83
Total RVUs 21.5
47
CPT Copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the AMA.
©2018 APA Practice Organization Promoting and supporting practicing psychologistsClinical Example 5:
Differential Diagnosis of Memory Loss/Early Alzheimer’s Disease
2 hour NSE+ 4 hours of technician testing + 2 hours of professional evaluation services
Code RVU
Clinical Interview/Neurobehavioral Status Examination (NSE)
Hour 1 96116 (Base Code; 1 unit@ 2.70) 2.70
Each additional hour 96121 (Add-on; 1 unit@ 2.32) 2.32
Test Administration/Data Gathering By Technician
First 30 minutes 96138 (Base Code; 1 unit@ 1.08) 1.08
Each additional 30 min 96139 (Add-on; 7units@ 1.08) 7.56
Testing Evaluation Services By QHP
Hour 1 96132 (Base Code ; 1 unit@ 3.71) 3.71
Hour 2 96133 (Add-on ; 1 unit@ 2.83) 2.83
Total RVUs 20.2
48
CPT Copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the AMA.
©2018 APA Practice Organization Promoting and supporting practicing psychologistsClinical Example 6:
Differential Diagnosis of Memory Loss/Early Alzheimer’s Disease
2 hour NSE+ 2 hours of technician testing + 2 hours of neuropsychologist testing + 2 hours of professional
evaluation services Code RVU
Clinical Interview/Neurobehavioral Status Examination (NSE)
Hour 1 96116 (Base Code; 1 unit@ 2.70) 2.70
Each additional hour 96121 (Add-on; 1 unit@ 2.32) 2.32
Test Administration/Data Gathering Psychologist
First 30 minutes 96136 (Base Code; 1 unit@ 1.33) 1.33
Each additional 30 min 96137 (Add-on; 3 units@ 1.23) 3.69
Test Administration/Data Gathering By Technician
First 30 minutes 96138 (Base Code; 1 unit@ 1.08) 1.08
Each additional 30 min 96139 (Add-on; 3units@ 1.08) 3.24
Testing Evaluation Services By QHP
Hour 1 96132 (Base Code ; 1 unit@ 3.71) 3.71
Hour 2 96133 (Add-on ; 1 unit@ 2.83) 2.83
Total RVUs 20.9
49
CPT Copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the AMA.
©2018 APA Practice Organization Promoting and supporting practicing psychologistsClinical Example 7:
A 70-year-old female presents with a history of failing memory. Her physician
arranges for the administration of a single automated cognitive test handed to
her by the clinical staff.
Psychological or neuropsychological test administration,
with single automated instrument via electronic platform,
with automated result only.
Code RVU
1 Unit 96146 0.06
[No physician work, just practice expense]
[Use of two or more tests requires Testing Evaluation Services]
CPT Copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the AMA. 50
©2018 APA Practice Organization Promoting and supporting practicing psychologistsFrequently Asked Questions
51
©2018 APA Practice Organization Promoting and supporting practicing psychologistsFrequently Asked Questions (FAQs)
In order to use the Testing Evaluation Services codes (96130-96133), must
the psychologist first perform Test Administration and Scoring services
(96136-96139)?
What about the scenario where you complete the testing but can't meet
with the family for feedback for a few weeks?
If I use 96133 for 31 minutes and then on another day do a “cognitive work
activity” (i.e. test evaluation services) do I add it to the first 96133 or is this
a separate 96133?
Can interactive feedback be conducted over the phone or are the codes
for face-to-face use only?
52
©2018 APA Practice Organization Promoting and supporting practicing psychologistsFrequently Asked Questions (FAQs)
How should we handle testing cases that are being scheduled or are
already scheduled for the end of 2018?
What if we administer only one test? What if it has many subtests like the
Wechsler Intelligence scales?
For 96146, do you bill this code twice if you give more than 1 automated
test?
53
©2018 APA Practice Organization Promoting and supporting practicing psychologistsAdditional Questions from the Audience
54
©2018 APA Practice Organization Promoting and supporting practicing psychologistsFor more information on CPT codes
APA Practice Organization: www.apapracticecentral.org
Click on Reimbursement in the top menu.
Psychology Coding - CPT and Psychological Service Billing:
http://psychologycoding.org/
55
©2018 APA Practice Organization Promoting and supporting practicing psychologistsRecent articles on this topic
Up-to-Code article providing guidance on how to use the new codes:
https://www.apapracticecentral.org/reimbursement/testing-codes/changes
Up-to-Code: New info on billing for psychological & neuropsychological assessment:
https://www.apapracticecentral.org/reimbursement/testing-codes/billing-psychological-
assessment.aspx
Reimbursing for services- http://www.apapracticecentral.org/update/2018/04-19/cms-
rulemaking-process.aspx
Up to code: Your money matters- http://www.apapracticecentral.org/update/2018/02-
08/money-matters.aspx
Up to code: What’s a RUC survey?- http://www.apapracticecentral.org/update/2017/05-04/ruc-
survey.aspx
56
©2018 APA Practice Organization Promoting and supporting practicing psychologistsStill have questions?
Join us on December 19th at 12pm EST- for a Question & Answer session
with Dr. Puente and Dr. Pliskin specifically to address any additional
questions you may have. A link to register will be sent out as a follow-up to
this presentation or you can view our News and Events page for the most
recent information on our webinar series:
https://www.apapracticecentral.org/news
57
©2018 APA Practice Organization Promoting and supporting practicing psychologistsBilling or other problems with private or
government insurance?
The APA Practice Organization assists members with health insurance and managed care
issues involving private and government insurers. The latter includes Medicare, Medicaid
and TRICARE. Issues include billing, contracting, restrictions on care, and parity & HIPAA
compliance. Approaches range from collaborative resolutions with enlightened
companies and agencies -- to complaints to regulators, lobbying federal and state
legislatures, and lawsuits.
For issues with private insurers, contact the APA Practice Organization at
PracticeLegalandRegulatory@apa.org.
For issues with government insurers, contact the APA Practice Organization at
PracticeGovRelations@apa.org.
58
©2018 APA Practice Organization Promoting and supporting practicing psychologistsAPA Membership
At APA, we support our members at every stage of their professional journey.
Join APA today and get the resources you need to help you develop new skills,
deepen your knowledge, and strengthen your professional identity.
APA also serves the field of psychology in varied and important ways. As a
member, your dues will help support public education programs that raise
awareness of the value of psychology. You’ll also make possible lobbying
efforts aimed at increasing funding for science and training, raising
reimbursement rates for practitioners, and convincing policymakers to apply
psychological science when addressing critical societal issues.
Not a member? Now is a great time to become one! Visit https://join.apa.org/
to join.
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©2018 APA Practice Organization Promoting and supporting practicing psychologistsThank you for attending today’s webinar.
A link to today’s recorded webinar will be emailed to all registrants within 48
hours. In addition, the slides and the recording will be available on the APA
Practice Organization website in a few weeks. (www.apapracticecentral.org)
We’d like your feedback on this webinar; with each recording email, there is a
link to a survey. We would appreciate it if you would take the time to fill it out.
Have a great day!
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