Psychological Testing Codes vs. Neuropsychological Testing Codes

Main Points

• Why did the codes change in 2019

• Definitions of the codes simplified

• The feedback codes vary between psychological and neuropsychological tests

The change to the new testing codes in 2019 caused quite an uproar in the testing and psychological community. The last change we saw a change to the testing codes was in 2014 when 96101, 96105, 96116, 96118, and 96125 were introduced.

However, after CMS evaluated the reimbursements based on these codes they found that reimbursements were influenced disproportionately by practice expenses and not the value of the services provided to patients. Therefore, with the help of CMS, American Medical Association (AMA), and the American Psychological Association (APA), the codes were changed. Here are some of the reasons why the codes changed:

• Practice expense was still dominating the reimbursement schedules

• Technology and instruments have advanced to accommodate more computer based and technician testing

• Reimburse based on “thinking time” vs. “doing time”

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Since the codes have changed, the definitions of the codes have been fairly ambiguous. We decided to put the definitions to the codes here in an understandable way:

Here are our definitions for our descriptions:

P: Psychologist

NP: Neuropsychologist

QHP: Qualified Health Professional

Psychological Testing Codes and Their Definitions

• 96136 - P or NP Test Administration/data gathering by QHP, first 30 minutes +96137 - P or NP test Administration/data gathering by QHP, add’l 30 minutes

• 96138 - P or NP Test Administration/data gathering by tech, first 30 minutes +96139 - P or NP Test Administration/data gathering by tech, add’l 30 minutes

• 96130 - P or NP testing services (interpretation, clinical decision making, feedback with patient, etc), first 60 minutes +96131 - P or NP testing services (interpretation, clinical decision making, feedback with patient, etc), each 60 minutes

Neuropsychological Testing Codes and Their Definitions

• 96136 - Same as above +96137 - Same as above

• 96138 - Same as above +96139 - Same as above

• 96132 - P or NP testing services (interpretation, clinical decision making, feedback with patient, etc), first 60 minutes +96133 - P or NP testing services (interpretation, clinical decision making, feedback with patient, etc), each 60 minutes

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Finally, you will notice the ONLY difference between the codes is the feedback codes. Therefore, depending on the tests that you are completing you can code the "doing" time the same way, but your "thinking" time is coded differently.

Look next week for a graphic representation of how the old testing codes translate to the new testing codes.

If you feel like you need more assistance with the testing codes feel free to fill out our contact form. A member of our team will be happy to reach out and schedule a time to help you with any questions you might have!