Summary & Overview
CPT 96105: Assessment of Aphasia and Cognitive Performance Testing
CPT code 96105 represents the assessment of aphasia and cognitive performance testing, a vital service in the evaluation of patients with neurological disorders impacting language and cognitive abilities. This code is widely recognized across the United States and is essential for clinicians such as neurologists, clinical neuropsychologists, and speech-language pathologists who diagnose and monitor conditions affecting the central nervous system.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, provide coverage for services billed under CPT code 96105. The publication offers a comprehensive overview of payer policies, clinical benchmarks, and recent policy updates relevant to this code. Readers will gain insights into the typical clinical scenarios where this assessment is utilized, the office-based nature of the service, and its role in the broader context of neurological and cognitive care.
Key topics include payer coverage details, common billing modifiers, associated provider taxonomies, and relevant ICD-10 diagnoses such as general paresis and various malignant neoplasms of the brain. The article also highlights related CPT codes and provides context for how 96105 fits within central nervous system assessment services. This summary equips healthcare professionals, billing specialists, and policy analysts with the information needed to understand the clinical and administrative landscape surrounding CPT code 96105.
CPT Code Overview
CPT code 96105 is used for the assessment of aphasia and cognitive performance testing. This procedure falls under the category of Central Nervous System Assessments/Tests and is typically performed in an office setting (Place of Service 11). The code is designed to capture the evaluation of language and cognitive abilities, which are critical for diagnosing and managing neurological conditions affecting communication and mental function.
Clinical & Coding Specifications
Clinical Context
A patient presents to the office with symptoms of language impairment following a neurological event, such as a stroke or brain tumor. The provider, often a speech-language pathologist, neurologist, or clinical neuropsychologist, conducts a structured assessment of aphasia and cognitive performance using standardized tools. The workflow includes patient history review, administration of cognitive and language tests, scoring, and interpretation. The results inform diagnosis, treatment planning, and documentation for payors such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
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Modifier
52(Reduced Services): Used when the assessment is performed but not to its full extent, such as when the patient cannot complete all test components. -
Modifier
59(Distinct Procedural Service): Applied when the assessment is performed separately from other procedures, indicating it is distinct and not bundled.
| Provider Taxonomy Code | Specialty |
|---|---|
2084N0400X | Neurology Physician |