CurrentBlue Cross Blue Shield - IllinoisPolicy CPCP008

Psychological and Neuropsychological Testing

Defines coding, billing and payment guidelines for psychological and neuropsychological testing services provided to Blue Cross and Blue Shield of Illinois members, including provider qualifications, allowed CPT codes, timing and frequency rules, and a catalog of tests.

Policy Summary

PayerBlue Cross Blue Shield - Illinois

PolicyPsychological and Neuropsychological Testing

Policy CodePolicy CPCP008

Change TypeNo material changes

Effective DateNov 6, 2024

Next Review Date

Key ActionEstablish medical necessity per PSY 301.020 before performing or billing for testing; submit claims upon completion of all testing-related services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Related Billing Codes

CPT-96105-APHASIA-EVALUATION-COMMUNICATION-ASSESSMENT

CPT 96105: Evaluation for Aphasia and Communication Ability

CPT-96121-EXTENDED-FACE-TO-FACE-COGNITIVE-ASSESSMENT

CPT 96121: Face-to-Face Extended Cognitive Assessment

CPT-96136-PSYCHOLOGICAL-NEUROPSYCHOLOGICAL-TEST-ADMINISTRATION-FIRST-30-MINUTES

CPT 96136: Psychological/Neuropsychological Test Administration and Scoring, First 30 Minutes

CPT-96139-TECHNICIAN-TEST-ADMINISTRATION-SCORING-ADDITIONAL-30-MINUTES

CPT 96139: Technician Administering and Scoring Tests, Additional 30 Minutes

CPT-96133-NEUROPSYCHOLOGICAL-TESTING-ADDITIONAL-HOUR

CPT 96133: Neuropsychological Testing, Additional Hour

96137-PSYCHOLOGICAL-OR-NEUROPSYCHOLOGICAL-TEST-ADMINISTRATION-AND

96137 – Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; each additional 30 minutes (List separately in addition to code for primary procedure)

CPT-96116-FACE-TO-FACE-COGNITIVE-ASSESSMENT-FIRST-HOUR

CPT 96116: Face-to-Face Cognitive and Judgment Assessment

CPT-96146-ELECTRONIC-SINGLE-TEST-AUTOMATED-SCORING

CPT 96146: Electronic Single-Test Psychological/Neuropsychological Assessment

CPT-96131-PSYCHOLOGICAL-TESTING-ADDITIONAL-HOUR

CPT 96131: Psychological Testing, Each Additional Hour

CPT-96130-PSYCHOLOGICAL-TESTING-INTERPRETATION-TREATMENT-PLAN-1HR

CPT 96130: Psychological Testing, Interpretation and Treatment Planning (First Hour)

Showing 1–10 of 16

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1/yrtesting limited frequency

8hneuropsych eval time

3-4hpsych testing time (routine)

16mmin for 30-min code

31mmin for hourly code

all agesage ranges covered

Coverage criteria and catalog guidance

inv-01: Coverage criteria for testing

Coverage is allowed when the following conditions are met:

ALL of the following

Tests are provided or overseen by appropriately licensed medical or mental health providers (Qualified Healthcare Professional or other licensed provider) who can administer, score and interpret psychological testing.
Medical necessity as defined by the Psychological and Neuropsychological Testing Policy (PSY 301.020) is established prior to testing.
Claims are submitted upon completion of all testing-related services (including pre-assessment planning, administration, scoring, integration of data, report write-up and feedback); if testing spans multiple days, submit the claim at the conclusion of all services.
Time-based CPT testing codes should follow the policy's time-based billing rules (time-based codes not billed concurrently for the same service period; base testing codes may be used only once per testing episode).
Only standardized tests with published national normative data producing standardized or scaled scores qualify for reimbursement.

CPT codes, test catalog and billing rules

Psychological and neuropsychological testing CPT codesCPT

96105	Assessment of Aphasia and Cognitive Performance Testing = ASSESSMENT OF APHASIA.
96110	Assessment of Aphasia and Cognitive Performance Testing = DEVELOPMENTAL SCREEN W/SCORE (For an emotional/behavioral assessment, use 96127).
96112	Assessment of Aphasia and Cognitive Performance Testing = DEVEL TST PHYS/QHP 1ST HR.
96113	Assessment of Aphasia and Cognitive Performance Testing = DEVEL TST PHYS/QHP EA ADDL (List separately in addition to code for primary procedure).
96116	Psychological/ Neuropsychological Testing = Neurobehavioral Status Exam = NUBHVL XM PHYS/QHP 1ST HR.
96121	Psychological/ Neuropsychological Testing = Neurobehavioral Status Exam = NUBHVL XM PHY/QHP EA ADDL.
96127	Assessment of Aphasia and Cognitive Performance Testing = BRIEF EMOTIONAL/BEHAV ASSMT (For developmental screening, use 96110).
96130	Psychological/ Neuropsychological Testing = Test Evaluation Services = PSYCL TST EVAL PHYS/QHP 1ST.
96131	Psychological/ Neuropsychological Testing = PSYCL TST EVAL PHYS/QHP EA.
96132	Psychological/ Neuropsychological Testing = NRPSYC TST EVAL PHYS/QHP 1ST.

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1/2

test catalog (no billing codes listed in these chunks)mixed

No codes listed

Test catalog entries (no billing codes in excerpt)mixed

No codes listed

Test catalog (no CPT/HCPCS codes listed in this section)mixed

No codes listed

CPT referenceCPT

No codes listed

Time-based billing rules — CPT

Concurrent time-based codesCPT time-based codes should not be billed concurrently for the same service period (e.g., do not bill a separate 30- or 60-minute testing code when testing occurs within a 60-minute therapy visit)

Base testing codes — single use per episodeBase psychological and neuropsychological testing codes (96112, 96116, 96130, 96132, 96136, 96138) may be used only once per testing episode; if testing spans multiple days, the base code is used once at the start of the episode

Submission timingClaims should be submitted upon completion of all testing-related services (including pre-assessment planning, administration, scoring, integration, report writing and feedback); if testing spans multiple days, submit at conclusion of services

Minimum minutes for time-based codesMinimum 16 minutes required to report a 30-minute code; minimum 31 minutes required to report any per-hour code

Prior authorization, documentation and actionables for providers

Prior Authorization

Establish medical necessity before testing

Medical necessity as defined by the Psychological and Neuropsychological Testing Policy (PSY 301.020) must be established prior to testing; claims should be submitted at completion of all testing-related services.

Prior Authorization

Medical necessity required prior to testing

Medical necessity as defined by the Psychological and Neuropsychological Testing Policy (PSY 301.020) must be established prior to testing.

Prior Authorization

Prior authorization / medical necessity

Medical necessity as defined by the Psychological and Neuropsychological Testing Policy (PSY 301.020) must be established prior to testing.

Terminology and catalog format definitions

Qualified Healthcare Professional (QHP)

DefinitionQualified Healthcare Professional (QHP) — an independently licensed provider who may bill QHP-only CPT codes (e.g., 96130-96133)

Billing restrictionCPT codes 96130-96133 may only be billed by a QHP who is independently licensed and contracted with the plan

Supervision distinctionIndividuals working or training under the supervision of a QHP are not QHPs for billing these codes and are considered technicians

Technician (definition & billing)

DefinitionTechnician — individuals working or training under the supervision of a QHP who do not qualify to bill QHP-only CPT codes

Applicable codesTest administration and scoring codes billed by technician: 96138 (first unit) and 96139 (each additional)

Testing catalog excerpts and background notes

This section lists entries from the policy's Test Catalog as a reference for providers. Entries include test name, intended use/type, applicable age ranges, and estimated administration and scoring times. The catalog is intended as an aid and does not itself establish coverage; medical necessity as defined by PSY 301.020 must be established prior to testing. Use the catalog for planning and documentation, and refer to the main policy for coding, billing, and coverage rules.

The catalog entries shown here are informational and may not include every covered instrument. Test administration and scoring times were calculated from established Tests in Print guidelines and test publisher guidance; additional time for Test Evaluation Services will depend on the tests used and accompanying clinical data. Remember that inclusion in this list does not replace the requirement that medical necessity per PSY 301.020 be met before testing is performed.

Catalog entries are formatted as: Test Name (Acronym/Type), Age, and Time (inclusive of administration and scoring). Use these time estimates for scheduling and selecting appropriate CPT time‑based codes, but follow the policy's billing rules (e.g., minimum minutes required to report 30‑minute or per‑hour codes and that time‑based codes should not be billed concurrently for the same service period). As with other catalog sections, medical necessity per PSY 301.020 must be established prior to testing and the list is not exhaustive.

Policy revision timeline

2024-11-06policy_effective_dateLatest

Policy effective date published as 2024-11-06.

2024-11-05last_review

Policy last reviewed on 2024-11-05.

Policy Summary

PayerBlue Cross Blue Shield - Illinois

PolicyPsychological and Neuropsychological Testing

Policy CodePolicy CPCP008

Change TypeNo material changes

Effective DateNov 6, 2024

Next Review Date

Key ActionEstablish medical necessity per PSY 301.020 before performing or billing for testing; submit claims upon completion of all testing-related services.

SourceLink

On This Page

Prior Authorization

Medical necessity must be established prior to testing

Medical necessity as defined by the Psychological and Neuropsychological Testing Policy (PSY 301.020) must be established prior to testing.

Prior Authorization

Confirm medical necessity per PSY 301.020 before testing

Medical necessity as defined by the Psychological and Neuropsychological Testing Policy (PSY 301.020) must be established prior to testing.

Prior Authorization

Medical necessity required before conducting tests

Medical necessity as defined by the Psychological and Neuropsychological Testing Policy (PSY 301.020) must be established prior to testing.

Supervision requirementTechnicians perform administration/scoring under QHP supervision; QHP must be appropriately licensed to oversee testing and interpretation

Comprehensive assessment

DefinitionComprehensive assessment — testing that goes beyond brief screenings or symptom inventories and uses comprehensive evaluation codes (psychological or neuropsychological)

Relevant CPT codesComprehensive assessments use CPT 96130-96133 and 96136-96139 when appropriate

Scope noteDo not use comprehensive assessment codes for brief screenings or monitoring during routine therapy or follow-up visits

Administration/scoring time (definition)

DefinitionAdministration and scoring time — estimated inclusive time for administering a test and scoring it as listed in the catalog (administration + scoring)

Source of estimatesTimes were calculated using Tests in Print guidelines and test publisher's guidelines

Use in planningUse catalog administration/scoring times to plan testing sessions; additional time for Test Evaluation Services may apply based on tests used and clinical data

Medical necessity (pre-testing requirement)

RequirementMedical necessity must be established prior to testing per the Psychological and Neuropsychological Testing Policy (PSY 301.020)

Claims and documentationProviders must document medical necessity; more than one testing claim per year may trigger medical records review

When requiredMedical necessity applies to all testing regardless of listing in the catalog; presence in the catalog is informational only

Catalog entry format

Format ruleCatalog entry format: Test Name, 1 = Acronym; Test Name, 2 = Type; Test Name, 3 = Age; Test Name, 4 = Time (inclusive of administration and scoring)

PurposeEntries provide acronym, intended use/type, age ranges, and estimated administration/scoring time as an aid to providers

Non-exhaustive noteCatalog is an aid and may not list all covered tests; medical necessity still required

Medical necessity (PSY 301.020)

Reference policyMedical necessity is defined by the Psychological and Neuropsychological Testing Policy (PSY 301.020) and must be met prior to testing

Catalog roleThis catalog is informational; it does not itself establish coverage — medical necessity per PSY 301.020 governs coverage

Documentation expectationProviders are responsible for submitting accurate documentation to demonstrate medical necessity when requested

Estimated inclusive time for administration and scoring

DefinitionEstimated inclusive time for administration and scoring — times listed in the catalog include both administration and scoring and were calculated from Tests in Print and publisher guidelines

ExamplesExamples in the catalog show times such as 15 min, 20 min, 30 min, up to multi-hour batteries depending on the test

ImplicationUse these inclusive times for scheduling; additional evaluation/reporting time may be billed separately per applicable CPT codes

Administration/Scoring times (catalog estimates)

DefinitionAdministration/Scoring times listed in the catalog are estimates inclusive of administration and scoring based on Tests in Print and publisher guidelines

Planning guidanceProviders should allow additional time for Test Evaluation Services beyond listed administration/scoring times when interpretation and report writing are required

Catalog limitationTimes are estimates and may vary by clinical context and the specific battery administered

Catalog entry format (concise)

Entry componentsCatalog entries list: Test Name = Acronym/Type; Age range; Time (inclusive of administration and scoring)

StandardizationEntries typically include target age ranges (infant to 90+ years where applicable)

Intended useEntries indicate test type (e.g., memory, attention, adaptive behavior) to assist provider selection

Time (inclusive of administration and scoring)

DefinitionTime (inclusive of administration and scoring) — listed catalog time that includes both administration and scoring activities for the test

SourceTimes were calculated using Tests in Print guidelines and publisher instructions

Scheduling noteUse listed inclusive times for test session planning; allow extra time for interpretation/reporting billed under evaluation codes

Tactile Performance Test (trial limit)

LimitTactile Performance Test — maximum of 3 trials per administration

Per-trial timeTactile Performance Test listed as 15 minutes per trial

Age rangeTactile Performance Test covers ages 5y–90y as listed in catalog