UPDATE: Tracking Medicare Adoption of New Testing Codes

Editor’s Note: This post was originally published on February 20, 2019, and has been completely updated to reflect the latest changes and information regarding Medicare coverage.

Medicare Administrative Carrier Novitas Solutions Inc. corrects non-coverage status for CPT 96138 and add-on code 96139

BrainCheck provides continuous tracking of the Centers for Medicare and Medicaid Services’ (CMS) implementation of new CPT codes and associated fees for neuropsychological testing that became effective January 1, 2019.

We posted recently that Novitas Solutions, a Medicare Administrative Carrier (MAC) for multiple states, had listed as non-covered items the new codes for neuropsychological test administration by a technician (CPT 96138-39) in its initial Local Coverage Determination (LCD). Multiple professional organizations got involved immediately to contest this decision.

We are delighted to report that this week Novitas Solutions published an updated LCD that now includes Neuropsychological Test Administration (initial half hour and add-on additional half hours) as covered codes. We believe that Novitas was the sole MAC regarding these codes as non-covered items, as other available LCDs clearly treated test administration as covered services, as was intended in the code revisions.

Immediate advocacy efforts seem to have rapidly corrected this initial unfavorable decision by the MAC. We would appreciate feedback from practices using BrainCheck to confirm that technician-administered tests are now being processed and paid, whether by Novitas or other MACs. We will continue to follow developments in the new coding era and keep you informed.

The information provided in this document was obtained from third-party sources and is subject to change without notice as a result of changes in reimbursement laws, regulations, rules, and policies. All content on this document is informational only, general in nature, and does not cover all situations or all payers’ rules and policies. This content is not intended to instruct medical providers on how to use or bill for healthcare procedures, including new technologies outside of Medicare national guidelines. A determination of medical necessity is a prerequisite that BrainCheck, Inc. assumes will have been made prior to assigning codes or requesting payments. Medical providers should consult with appropriate payers, including Medicare fiscal intermediaries and carriers, for specific information on proper coding, billing, and payment levels for healthcare procedures. This information represents no promise or guarantee by BrainCheck, Inc. concerning coverage, coding, billing, and payment levels. BrainCheck, Inc. specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on this information.

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