Key considerations for billing CPT code 96132

The 2019 coding changes announced by the Centers for Medicare and Medicaid Services (CMS) provide new guidelines for neurocognitive testing that can provide additional revenue opportunities for practitioners.

What’s changed?

    • The guideline modifications separate Test Administration from Test Evaluation, a sorely needed clarification from the old method.
    • A second and very positive addition is that the codes for Test Evaluation recognize the time spent by doctors over and above face-to-face activity; that activity may include review of patient history, review of medical records, and time spent documenting the testing results in the medical record.

Code 96132

The core physician code for billing neurocognitive testing evaluation will be Current Procedural Terminology (CPT®) code 96132, described as follows:

Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour.

Physicians should use CPT 96138 when billing for neuropsychological test administration.

Reimbursement and documentation for 96132

Medicare payment for this code is $133.56 (subject to geographic adjustment) for the first hour of activity. If additional time is spent in association with the testing, additional hours are billed using add-on code 96133, paid at $101.88.

The physician’s documentation of neurocognitive testing should include these elements:

    1. Reason for testing (establishing medical necessity)
    2. Tests administered
    3. Relevant medical history
    4. Report of test scores and percentiles
    5. Interpretation of test scores
    6. Clinical decision making (additional tests, medication changes, specialist referral, etc.)
    7. Changes in treatment plan in light of test results
    8. Documentation of feedback to patient/family

CMS recognizes that the face-to-face time spent with the patient and the additional physician cognitive time associated with the testing may span several days.

Considerations for billing 96132

Consensus recommendations regarding this code are that the code be billed on the date of service for the final activity. In most cases, this will be the day that the report is entered into the medical record. Many times, the patient/family will return for another visit for interpretation and feedback of test results.

In order to be billable as an add-on code, this visit must be face-to-face, not telephonic. In addition, the physician activity must aggregate to an additional hour (greater than 31 minutes) to justify billing the add-on code. If the patient is returning for a more comprehensive follow-up visit, billed with an E/M code, there should be documentation that feedback was provided to the patient even if the feedback is not a separately billable event.

Questions?

BrainCheck will continue to track and disseminate information about the adoption of the applicable 2019 CPT codes. We appreciate any feedback you can provide, particularly any experiences you have in billing the new codes. We can be reached at info@braincheck.com.


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.