CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Psychological and Neuropsychological Testing (non–learning disabilities)

Defines specialty restrictions, provider and annual-per-provider/group reimbursement limits for psychological and neuropsychological testing codes when performed for disorders other than learning disabilities. Applies to BlueCHiP for Medicare and Commercial products.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyPsychological and Neuropsychological Testing (non–learning disabilities)

Policy CodePolicy N/A

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionEnsure testing claims are submitted by the authorized specialty or facility and include qualified healthcare professional interpretation and a report.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

6 hoursAggregate annual reimbursable technician/psychologist hours (per provider/group)

10 hoursAggregate annual reimbursable hours for specified neuropsychological testing (per provider/group)

10 hoursAggregate annual reimbursable hours for standardized cognitive performance testing (per provider/group)

When Psychological and Neuropsychological Testing Is Covered

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Relevant CPT Codes and Coverage Status

Subject to specialty restriction and annual limits (6-hour limit)CPTCovered

96102	Psychological testing administered by technician, per hour of technician time, with interpretation and report
96101	Psychological testing by psychologist/physician, per hour (face-to-face and interpretation/report)

Subject to specialty restriction and annual limits (10-hour limit)CPTCovered

96118	Neuropsychological testing, per hour of psychologist/physician time (face-to-face and interpretation/report)
96116	Neurobehavioral status exam, per hour of psychologist/physician time (face-to-face and interpretation/report)
96119	Neuropsychological testing administered by technician, per hour of technician time, with interpretation and report

Covered, specialty restriction applies but NOT impacted by reimbursement limitsCPTCovered

96103	Psychological testing administered by computer; with qualified healthcare professional interpretation and report
96111	Developmental testing; extended, with interpretation and report

Covered as medical services — not impacted by limits or specialty restrictionsCPTCovered

96105	Assessment of aphasia, with interpretation and report, per hour
96120	Neuropsychological testing administered by computer; with interpretation and report (note: used for IMPACT screening)
96110	Developmental testing; limited, with interpretation and report

Standardized cognitive performance testing (limited specialties)CPTCovered

96125

Standardized cognitive performance testing, per hour of qualified healthcare professional time (face-to-face and interpretation/report)

Billing, Documentation, and Operational Requirements

Billing Rule

Facility claims for Hospital Based Clinic

When services are rendered in a Hospital Based Clinic by an authorized specialty, claims must be filed by the facility.

Documentation Required

Report and interpretation required

The following CPT codes require qualified healthcare professional interpretation and a report; time includes face-to-face testing and time interpreting results and preparing the report.

96101
96102
96116
96118
96119
96125
96103
96111
96105
96110
96120

Billing Rule

Daily maximum unit edits

Daily maximum unit edits are applicable as noted in the referenced Coding and Payment Guideline policy.

Clinical and Administrative Context

This policy provides background and important program-level notes about psychological and neuropsychological testing. These tests measure cognitive, psychomotor and other abilities and typically generate material that is formulated into a written report. Neuropsychological testing assesses functions such as memory, abstract reasoning, attention/concentration, executive function and motor skills; the IMPACT screening (CPT 96120) is a computerized neurocognitive assessment used in concussion screening and is included in the scope of related testing.

Benefits and coverage may vary by group or contract. For member-specific coverage of diagnostic testing or behavioral health services, refer to the member’s Subscriber Agreement or Evidence of Coverage. If services are provided under an Early Intervention Program, follow the related Early Intervention Policy for applicable guidance and billing rules.

Psychological and neuropsychological testing when performed to evaluate learning disabilities are not covered services under this policy.

Defined Terms

Definitions

Psychological testingSeries of tests used to evaluate emotional, psychiatric, neuropsychiatric, personality illnesses, or developmental testing; administration generates material that is formulated into a report.

Neuropsychological testingTesting used to determine the brain's capacity in memory, reasoning, attention, executive function, motor skills and other cognitive/psychological factors.

IMPACT screeningComputerized neurocognitive assessment tool used in concussion screening; CPT 96120 referenced for IMPACT screening.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyPsychological and Neuropsychological Testing (non–learning disabilities)

Policy CodePolicy N/A

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionEnsure testing claims are submitted by the authorized specialty or facility and include qualified healthcare professional interpretation and a report.

SourceLink

On This Page

OpenPayer

Psychological and Neuropsychological Testing (non–learning disabilities)

When Psychological and Neuropsychological Testing Is Covered

Relevant CPT Codes and Coverage Status

Billing, Documentation, and Operational Requirements

Clinical and Administrative Context

Defined Terms

Annual Reimbursement Limits (Per Provider/Group)

Psychological and Neuropsychological Testing (non–learning disabilities)

When Psychological and Neuropsychological Testing Is Covered

Relevant CPT Codes and Coverage Status

Billing, Documentation, and Operational Requirements

Clinical and Administrative Context

Defined Terms

Policies to Review Alongside This One

Annual Reimbursement Limits (Per Provider/Group)