As a psychologist or mental health professional, testing and diagnosis are critical to the care you provide. But to continue that care, you must get paid — or reimbursed —- appropriately.
Like much of the billing and revenue cycle management (RCM) process, coding your claims can take some time to master. In this guide, we’ve compiled some of the most common psychological testing CPT codes and behavioral health billing best practices to help you get full reimbursement from insurers.
What Are Psychological Testing CPT Codes?
Psychological testing CPT codes (or current procedural terminology codes) are five-digit codes that psychologists and therapists use to bill insurance providers for specific psychological and neuropsychological tests. These tests help clinicians assess patients’ symptoms to determine a diagnosis, ultimately dictating the treatment plan.
It’s important to note that there are specific codes for test administration and scoring, which are different from codes for evaluation. Codes also vary depending on whether a psychologist, neuropsychologist or technician did the test.
Most Common CPT Codes for Psychological Testing
Generally, psychological testing CPT codes range from 96105-96146. Below are the codes you’ll likely come across when billing insurance for psychological testing.
Cognitive Performance Tests
|Aphasia assessment, including interpretation and report. Bill this code for each hour of assessment.
|Standard cognitive performance testing. This includes time administering the test, interpreting results and preparing the report. Bill this code for each hour spent on testing, interpretation and reporting.
Developmental/Behavioral Testing (Including Autism Testing)
|Developmental screening, such as an assessment for speech/language delay or a standard developmental milestone assessment. This code includes interpretation and reporting. This test is sometimes used for autism screening, depending on the clinical situation.
|Not paid by Medicare. Use HCPCS Level II code G0451 instead. This pays $10.84.
|Developmental testing by a physician or other qualified healthcare professional. This can include testing gross motor, language, cognitive level, social, memory and/ or executive functions by standardized developmental instrument. This code includes testing interpretation and reporting. It covers one hour only.
|Use this code for each additional 30 minutes of developmental testing. Use code 96112 for the first hour.
|A brief emotional or behavioral assessment, with scoring and documentation. This can include a depression inventory or ADHD scale.
Psychological/Neuropsychological Testing (Including Autism Testing)
|A neurobehavioral status exam done by a physician or qualified healthcare professional. This exam may include clinical assessment of thinking, reasoning and judgment, such as acquired knowledge, attention, language, memory, planning and problem-solving, and visual-spatial abilities. This code, which covers one hour, includes test interpretation and reporting. You can also use this code for autism assessment tools such as the Autism Diagnostic Interview-Revised or Childhood Autism Rating Scale that you do not directly administer to the child.
|Use this code for each additional hour of the neurobehavioral status exam. Use code 96116 for the first hour.
|Psychological test evaluation done by a physician or qualified healthcare professional. This code is for the first hour of evaluation. Evaluation can include interpreting standardized test results, clinical decision-making, integrating patient data, treatment planning, and providing feedback to the patient, family or caregiver.
|Use this code for each additional hour of psychological test evaluation. Use code 96130 for the first hour.
|Neuropsychological test evaluation done by a physician or qualified healthcare professional. This code is for the first hour of evaluation. Evaluation can include interpreting standardized test results, clinical decision-making, integrating patient data, treatment planning, and providing feedback to the patient, family or caregiver.
|Use this code for each additional hour of psychological test evaluation. Use code 96132 for the first hour. You can bill for an additional hour of service as long as you've provided services for at least 31 additional minutes.
Test Administration and Scoring by a Psychologist or Neuropsychologist
|Psychological or neuropsychological test administration and scoring done by a physician or qualified healthcare professional. Use this code for two or more tests, any method. This code includes the first 30 minutes of testing and scoring.
|Use this code for each additional 30 minutes of testing and scoring done by a physician or qualified healthcare professional. Use code 96136 for the first 30 minutes.
Test Administration and Scoring by a Technician
|Psychological or neuropsychological test administration and scoring done by a technician. Use this code for two or more tests, any method. This code includes the first 30 minutes of testing and scoring.
|Use this code for each additional 30 minutes of testing and scoring done by a technician. Use code 96138 for the first 30 minutes. You can bill for an additional 30 minutes of testing (96139) as long as you've done testing for at least 16 additional minutes.
|Psychological or neuropsychological testing with a single automated instrument via an electronic platform, with automated results only.
Best Practices for Billing Psychological Testing CPT Codes
Understanding the correct psychological testing CPT codes is an important first step to getting paid by insurance companies. But following a few best practices will ensure you get paid quickly and successfully.
Verifying your patient’s insurance is the first step to ensuring a smooth claim process. Establish a workflow that confirms insurance before you conduct testing, making sure to double-check the patient’s demographic information and plan ID number. If there are coverage issues, contact the patient and remedy the problems before the appointment.
Get Pre-Authorization (If Needed)
Some psychological and neuropsychological testing require pre-authorization (or prior authorization) from insurance companies. Make sure you and your staff understand the specific pre-authorization requirements for each payer. These requirements can include submitting patient documentation and clinical assessments.
Remember that pre-authorizations can take time, so don’t wait until the last minute to submit. Also, remember that pre-authorizations are only valid for a certain amount of time and you must conduct the testing within that period. Otherwise, the payer may not reimburse you for the testing.
Create Thorough Documentation
Throughout the assessment, testing and evaluation process, keep detailed documentation. The more information you provide to an insurance company justifying the testing, the more likely they will fully reimburse your claim.
Know Payer-Specific Filing Rules
Every payer has different filing rules, so it’s important you and your team know the procedure for each. For example, some payers require you to bill evaluation and testing codes on the same claim. Even if you perform the evaluation and testing on different days, submitting them on the same claim may avoid a rejection.
File On Time
Don’t forget that payers have time limits for how long you have to file a claim after a test is completed (also called timely filing requirements). The payer may not reimburse your claim if you file outside this period. The timely filing periods can vary across payers, although most fall in the 90-, 180- or 365-day timeframe.
Stay In the Loop With Payer Changes
Payers are constantly making adjustments to their claim submission rules and requirements. Staying current with these requirements can help ensure your practice sees better reimbursement rates and fewer denials and rejections.
Get Reimbursed Successfully for Your Psychological Testing
There’s plenty to manage within your private practice, but one of the most important tasks is making sure you and your clinicians get reimbursed for the care you provide. Without these reimbursements, maintaining a healthy revenue stream will be challenging for your practice.
While understanding the intricacies of psychological testing CPT codes can help improve your reimbursement rates, following essential billing best practices will make an even bigger difference. Verifying insurance, getting pre-authorization, creating thorough documentation and filing on time are all critical steps to ensuring your business can grow and thrive.
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