CPT CODE and Description
96116 - Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), per hour of the psychologist's or physician's time, both face-to-face time with the patient and time interpreting test results and preparing the report - Average fee amount - $75 - $110
96118 - Neuropsychological testing (eg, Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), per hour of the psychologist's or physician's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report
96119 - Neuropsychological testing (eg, Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), with qualified health care professional interpretation and report,
96120 - Neuropsychological testing (eg, Wisconsin Card Sorting Test), administered by a computer, with qualified health care professional interpretation and report
CPT Codes for Diagnostic Psychological and Neuropsychological Tests
The range of CPT codes used to report psychological and neuropsychological tests is 96101- 96120. CPT codes 96101, 96102, 96103, 96105, and 96111 are appropriate for use when billing for psychological tests. CPT codes 96116, 96118, 96119 and 96120 are appropriate for use when billing for neuropsychological tests.
All of the tests under this CPT code range 96101-96120 are indicated as active codes under the physician fee schedule database and are covered if medically necessary.
Coding Guidelines:
References to providers throughout this policy include non-physicians, such as clinical psychologists, independent psychologist, nurse practitioners, clinical nurse specialists and physician assistants when the services performed are within the scope of their clinical practice/education, licensed and authorized under the state law A minimum of 31 minutes must be provided to report any per hour code. Services 96101, 96116, 96118 and 96125 report time as (a) face–to-face with the patent and (b) time spent interpreting and preparing the report.
Typically, the neuropsychological evaluation requires 4-8 hours to perform, including administration, scoring, interpretation, report writing and interpretation to the patient and/or family. If the evaluation is performed over several days, the time should be combined and reported all on the last day of service .
CPT code equivalents of the most common components of the neuropsychological assessment include:
1. Direct clinical observation and interview with the patient, often with caregivers or significant others who serve as sources of information that the patient may be unable to provide (e.g., spouse, parent, adult child, care staff, therapists),
96116;
2. Review of medical records and, in some cases, other relevant records (e.g., work history, educational history, criminal or social services records, etc.), 96118;
Q: Can I perform psychological testing and psychotherapy on the same date of service?
A: No, the following therapy codes will be considered not separately reimbursed if provided on the same date of service as 96101, 96102, 96116, 96118, or 96119: 90804, 90805, 90806, 90807, 90808, 90809, 90810, 90811, 90812, 90813, 90814, 90815, 90823, 90824, 90826, 90827.
Reimbursement changes for CPT code 96116
Clinical evaluation of thinking and other mental functions is ingrained into every day medical practice. Assessment can be as simple as recognition by the practitioner that a long-standing patient seems unable to report details and grasp the significance of a clinical situation or as complicated as an extensive battery of tests to sort out complex deficits. Several central nervous system assessment codes describe a middle ground. The examination is more detailed than a comprehensive evaluation and management examination, but less systematic and thorough than a comprehensive battery of
psychological or neuropsychological testing. Practices depend on the proper use of Current Procedural Terminology (CPT).
One of these codes is 96116- neurobehavioral status exam. It is defined in the CPT manual as ‘neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), per hour of the psychologist’s or physician’s time, both face to face time with the member and time interpreting test results and preparing the report.’
We are implementing a new reimbursement policy that follows the CPT guidance restricting billable use of this code to psychologists and/or physicians. In addition, there will be a limit of 5 hours/units per year, to help ensure the code is being used consistently. Instances of services exceeding 5 hours/units per year are subject to review for case-specific detail This February 2014 Connecticut 14 of 20 policy applies to all commercial Anthem health plans. (Please note that Medicaid and Medicare plans may have additional regulation and other guidance about utilization.)
96116 Testing & Interpretation Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, e.g., acquired knowledge, attention, language, memory, planning and problem Striving, and visual spatial abilities), per hour of the psychologist's or physician's time, both face-to-face time with the patient and time interpreting test results and preparing the report. $93
6. CPT code 96116 may be utilized by a neuropsychologist in lieu of 90791 to bill for an initial neuropsychological assessment visit, and may be utilized to bill for a 1 hour neurocognitive evaluation.
7. A psychologist who bills for services delivered by a psychometrist, psychometrician or CPA should use CPT code 96102 (for psychological testing) or 96119 (for neuropsychological testing).
8. A psychologist who bills for testing administered by computer should use CPT Code 96103 (psychological testing) or 96120 (for neuropsychological testing).
9. The Wada hemispheric activation test (CPT code 95958) is an open brain pre-surgical procedure when neuropsychological tests are administered along with EEG monitoring to determine the hemisphere of the brain responsible for cognitive functions such as speed and memory. The neuropsychological testing component is sometimes billed using the 65958 CPT code or may be billed using the 96118 neuropsychological testing CPT code. The neuropsychological testing component of the Wada test may be covered as a medical benefit.
96020 – Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered by a psychologist or physician, with review of test results and report. Note that CPT code 96020 should not be used in conjunction with 96101-96103, 96116, or 96120.
Neurobehavioral Status Exam
96116 – Neurobehavioral Status Exam: Clinical assessment of thinking, reasoning and judgment (e.g., acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), per hour of psychologist's or physician's time, both
8 face-to-face time with the patient and time interpreting test results and preparing the report.
What modifiers are valid when billed with Healthcare Common Procedure Coding System (HCPCS) code 96116?
Effective January 1, 2008, the following modifiers are valid when billed with HCPCS code 96116:
• GT – Via interactive audio and video telecommunications system
96116 - Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), per hour of the psychologist's or physician's time, both face-to-face time with the patient and time interpreting test results and preparing the report - Average fee amount - $75 - $110
96118 - Neuropsychological testing (eg, Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), per hour of the psychologist's or physician's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report
96119 - Neuropsychological testing (eg, Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), with qualified health care professional interpretation and report,
96120 - Neuropsychological testing (eg, Wisconsin Card Sorting Test), administered by a computer, with qualified health care professional interpretation and report
CPT Codes for Diagnostic Psychological and Neuropsychological Tests
The range of CPT codes used to report psychological and neuropsychological tests is 96101- 96120. CPT codes 96101, 96102, 96103, 96105, and 96111 are appropriate for use when billing for psychological tests. CPT codes 96116, 96118, 96119 and 96120 are appropriate for use when billing for neuropsychological tests.
All of the tests under this CPT code range 96101-96120 are indicated as active codes under the physician fee schedule database and are covered if medically necessary.
Coding Guidelines:
References to providers throughout this policy include non-physicians, such as clinical psychologists, independent psychologist, nurse practitioners, clinical nurse specialists and physician assistants when the services performed are within the scope of their clinical practice/education, licensed and authorized under the state law A minimum of 31 minutes must be provided to report any per hour code. Services 96101, 96116, 96118 and 96125 report time as (a) face–to-face with the patent and (b) time spent interpreting and preparing the report.
Typically, the neuropsychological evaluation requires 4-8 hours to perform, including administration, scoring, interpretation, report writing and interpretation to the patient and/or family. If the evaluation is performed over several days, the time should be combined and reported all on the last day of service .
CPT code equivalents of the most common components of the neuropsychological assessment include:
1. Direct clinical observation and interview with the patient, often with caregivers or significant others who serve as sources of information that the patient may be unable to provide (e.g., spouse, parent, adult child, care staff, therapists),
96116;
2. Review of medical records and, in some cases, other relevant records (e.g., work history, educational history, criminal or social services records, etc.), 96118;
Q: Can I perform psychological testing and psychotherapy on the same date of service?
A: No, the following therapy codes will be considered not separately reimbursed if provided on the same date of service as 96101, 96102, 96116, 96118, or 96119: 90804, 90805, 90806, 90807, 90808, 90809, 90810, 90811, 90812, 90813, 90814, 90815, 90823, 90824, 90826, 90827.
Reimbursement changes for CPT code 96116
Clinical evaluation of thinking and other mental functions is ingrained into every day medical practice. Assessment can be as simple as recognition by the practitioner that a long-standing patient seems unable to report details and grasp the significance of a clinical situation or as complicated as an extensive battery of tests to sort out complex deficits. Several central nervous system assessment codes describe a middle ground. The examination is more detailed than a comprehensive evaluation and management examination, but less systematic and thorough than a comprehensive battery of
psychological or neuropsychological testing. Practices depend on the proper use of Current Procedural Terminology (CPT).
One of these codes is 96116- neurobehavioral status exam. It is defined in the CPT manual as ‘neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), per hour of the psychologist’s or physician’s time, both face to face time with the member and time interpreting test results and preparing the report.’
We are implementing a new reimbursement policy that follows the CPT guidance restricting billable use of this code to psychologists and/or physicians. In addition, there will be a limit of 5 hours/units per year, to help ensure the code is being used consistently. Instances of services exceeding 5 hours/units per year are subject to review for case-specific detail This February 2014 Connecticut 14 of 20 policy applies to all commercial Anthem health plans. (Please note that Medicaid and Medicare plans may have additional regulation and other guidance about utilization.)
96116 Testing & Interpretation Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, e.g., acquired knowledge, attention, language, memory, planning and problem Striving, and visual spatial abilities), per hour of the psychologist's or physician's time, both face-to-face time with the patient and time interpreting test results and preparing the report. $93
6. CPT code 96116 may be utilized by a neuropsychologist in lieu of 90791 to bill for an initial neuropsychological assessment visit, and may be utilized to bill for a 1 hour neurocognitive evaluation.
7. A psychologist who bills for services delivered by a psychometrist, psychometrician or CPA should use CPT code 96102 (for psychological testing) or 96119 (for neuropsychological testing).
8. A psychologist who bills for testing administered by computer should use CPT Code 96103 (psychological testing) or 96120 (for neuropsychological testing).
9. The Wada hemispheric activation test (CPT code 95958) is an open brain pre-surgical procedure when neuropsychological tests are administered along with EEG monitoring to determine the hemisphere of the brain responsible for cognitive functions such as speed and memory. The neuropsychological testing component is sometimes billed using the 65958 CPT code or may be billed using the 96118 neuropsychological testing CPT code. The neuropsychological testing component of the Wada test may be covered as a medical benefit.
96020 – Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered by a psychologist or physician, with review of test results and report. Note that CPT code 96020 should not be used in conjunction with 96101-96103, 96116, or 96120.
Neurobehavioral Status Exam
96116 – Neurobehavioral Status Exam: Clinical assessment of thinking, reasoning and judgment (e.g., acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), per hour of psychologist's or physician's time, both
8 face-to-face time with the patient and time interpreting test results and preparing the report.
What modifiers are valid when billed with Healthcare Common Procedure Coding System (HCPCS) code 96116?
Effective January 1, 2008, the following modifiers are valid when billed with HCPCS code 96116:
• GT – Via interactive audio and video telecommunications system