UPDATED MAY 4, 2020: Guidance for telehealth CPT codes for cognitive testing has been further revised by CMS as of April 30. With this updated guidance, practices can now reimburse for CPT 96138, CPT 96132, and CPT 99483 services conducted over the phone. CMS has also increased the payments for telephone visits to match payments for office and outpatient visits, and has allowed the payments to be retroactive to March 1, 2020.
Recent changes have expanded access to telemedicine during the current public health emergency. But until early April, the information about telehealth CPT codes for cognitive testing and other services had been less specific.
However, CMS has announced an expanded list of 85 additional Medicare services that will be eligible for telehealth reimbursement. Those services include CPT 96132–96139, which concern neurocognitive test administration and interpretation. CPT 99483 for cognitive care planning has also been included.
Test Administration: CPT 96138 and CPT 96136
The standard codes for cognitive assessment administration are CPT 96138 and CPT 96136:
CPT 96138 – “Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes”
CPT 96136 – “Psychological or neuropsychological test administration and scoring by clinician, two or more tests, any method; first 30 minutes”
These codes remain the recommended billing method for administration of remote cognitive testing. Cognitive assessments administered remotely should use POS-02.
Test Interpretation: CPT 96132
Continued use of CPT 96132, the standard code for cognitive assessment interpretation is also recommended:
CPT 96132 – “Neuropsychological testing evaluation services by physician or other qualified health professional.”
The primary purpose of CPT 96132 is to compensate physicians for their time to interpret test results and modify treatment plans. POS-11 (in office) or POS-02 (telehealth) may be used, but not both.
For this code, interactive feedback is a potential component, but not required. Temporary changes to HIPAA requirements, however, makes interaction much more accessible. Interactions with patients can take place over the phone or on a consumer video chat platform.
Neurobehavioral Status Exam: CPT 96116
Primarily, BrainCheck suggests using CPT Codes 96138/96136 and CPT 96132 for cognitive assessment administration and interpretation. But practices may also consider CPT 96116 as an alternative telehealth CPT codes for cognitive testing:
CPT 96116 – “Neurobehavioral status examination (clinical assessment of thinking, reasoning, and judgment, (e.g. acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), by physician or other qualified health professional, both face-to-face time with the patient and time interpreting test results and preparing report; first hour.”
The BrainCheck standard battery, combined with a few additional questions, can meet the requirements for CPT 96116. This code reimburses for approximately 30 percent less than combining CPT 96138/96136 and CPT 96132.
Continued Importance of Cognitive Care
Right now, the importance of continuing to provide cognitive care for patients cannot be overemphasized.
Early detection and intervention remains essential for those with cognitive impairment, in addition to tracking changes in individuals with established impairment. These changes may indicate progression of a neurodegenerative disease or herald a medical illness needing urgent attention.
As of this week, U.S. officials have extended social distancing guidelines until the end of April. Depending on when the spread begins to slow, these measures may be in place for some time.
Also, in-person neuropsychology testing is currently on hold in most places, eliminating a major diagnostic aid.
Increased access to telemedicine and remote cognitive testing using BrainCheck can offer a way for practices to continue to provide high-quality care — while providing a critical source of revenue.