It has recently come to our attention that effective April 1, 2019, practitioners billing for CPT® codes 96138 (neurocognitive test administration) and 96132 (test interpretation, decision-making) should now use a -59 modifier on the procedure codes instead of adding a -25 modifier on the evaluation and management (E/M) service code 99214 for reporting an unrelated E/M service.

This change is a result of an edit to the existing National Correct Coding Initiative (NCCI) edits.

Previously, NCCI edits placed 96138 and 96132 into Column One and E/M services in Column Two. Under NCCI, Column Two codes are considered bundled if performed for the same condition. However, the Centers for Medicare and Medicaid Services (CMS) have recently swapped the designation of these codes.

What these changes mean for you

For situations where your practice previously billed a -25 modifier with your E/M code and no modifier on 96138 and 96132, this simply means removing the -25 modifier and adding a -59 modifier to the administration and interpretation.

In the case where other procedures are billed in addition to BrainCheck, a -25 modifier would be required on the E/M code as well as a -59 modifier on 96138 and 96132.

Here are some sample scenarios:

Modifier sample scenarios for cpt codes 96138 and 96132

Questions?

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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.