Psychological and Neuropsychological Testing and Evaluation Services
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Defines coverage, coding, provider qualifications, and billing guidance for psychological and neuropsychological testing and evaluation services for Blue KC lines of business; applies to professional providers performing or supervising these services.
Psychiatrist added to list of providers allowed to bill psychological and neuropsychological testing.
Corrected transposed CPT code.
Initial policy version published.
Coverage Criteria for Psychological and Neuropsychological Testing
Covered services with criteria
Covered when ALL of the following are met
Psychiatrist included per policy.
96136 and 96138 cannot be billed on the same day for the same patient without an appropriate modifier per NCCI edit.
Brief emotional/behavioral assessment (e.g., ADHD scale) is reported with CPT 96127 including scoring and documentation per standardized instrument.
Screening specifically for attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) should be submitted using CPT 96127. Providers should not use psychological or neuropsychological testing codes (e.g., 96130–96139) for routine ADD/ADHD screening. These brief emotional/behavioral assessment services include scoring and documentation per a standardized instrument and are the appropriate claim submission for screening purposes.
An NCCI edit prevents reporting both 96136 and 96138 for the same patient on the same day unless an appropriate modifier is appended. When a psychologist or other qualified health care professional personally administers testing, report 96136 (first 30 minutes) and 96137 for each additional 30-minute increment; when a technician administers testing under general supervision, report 96138 (first 30 minutes) and 96139 for each additional 30-minute increment. Professional oversight of technician-administered services should be captured with the professional evaluation service codes (96130–96133) as applicable.
Coding and Time Increments
| 96130 | Psychological testing evaluation services by physician or other qualified health care professional; first hour |
| 96131 | Psychological testing evaluation services; each additional hour |
| 96132 | Neuropsychological testing evaluation services by physician or other qualified health care professional; first hour |
| 96133 | Neuropsychological testing evaluation services; each additional hour |
| 96136 | Psychological or neuropsychological test administration and scoring by physician/QHP, two or more tests; first 30 minutes |
| 96137 | Psychological or neuropsychological test administration and scoring by physician/QHP; each additional 30 minutes |
| 96138 | Psychological or neuropsychological test administration and scoring by technician, two or more tests; first 30 minutes |
| 96139 | Psychological or neuropsychological test administration and scoring by technician; each additional 30 minutes |
| 96127 | Brief emotional/behavioral assessment (e.g., depression inventory, ADHD scale) — screening for ADD/ADHD |
Provider Actions, Billing and Documentation Requirements
Verify member eligibility / prior authorization
Verify member eligibility, benefits, and prior authorization requirements before delivering services. Coverage is determined by the date of service, the member's eligibility and benefit limits, the Provider Service Agreement, and applicable coding rules and guidelines. Final payment is subject to claims adjudication and industry edits. Contact Blue KC provider hotlines for coverage confirmation.
- Coverage determined by date of service and member eligibility
- Confirm benefit limits and Provider Service Agreement terms
- Contact Blue KC Provider Hotline for Commercial lines of Business 816-395-3929; ACA Provider Hotline 866-859-3822; Blue Medicare Advantage Provider Hotline 866-508-7140
ADHD/ADD screening code guidance
Screening for ADD/ADHD should be reported using CPT 96127 (brief emotional/behavioral assessment with scoring and documentation). Do not report ADD/ADHD screening using the full psychological or neuropsychological testing codes.
- Use CPT 96127 for brief screening and scoring of ADHD/ADD
- Do not bill comprehensive psychological/neuropsychological testing codes for ADHD/ADD screening
Provider qualifications and supervision documentation
Psychological and neuropsychological testing services must be provided or overseen by appropriately licensed medical or mental health providers in their state of practice who are qualified to administer, score, and interpret testing. When technicians are used for test administration or scoring, the supervising psychologist or qualified health professional (QHP) must provide general supervision, clinical decision-making, and be responsible for instrument selection, data interpretation, report-writing, consultation, and feedback. Technician training and permitted activities vary by state; the licensed psychologist or QHP retains responsibility and must document supervision.
- Tests must be provided or overseen by state-licensed psychologists, psychologists, psychiatrists, or appropriate QHPs
- Technician-conducted administration/scoring requires documented general supervision by the licensed psychologist or QHP
- Supervising clinician is responsible for instrument selection, interpretation, report-writing, and clinical decision-making
- Document technician training, supervision, and which portions of administration/scoring were performed by technician vs. licensed clinician
Coverage and documentation checklist
Before billing, ensure member eligibility, benefit limits, and applicable coding rules align with services performed. Verify that ADHD/ADD screening was billed with CPT 96127 when appropriate and that supervision and provider qualifications are documented per state licensing rules and this policy.
- Coverage determined by date of service, member eligibility, benefit limits, Provider Service Agreement, and coding rules
- ADHD/ADD screening = CPT 96127; do not use comprehensive testing codes for screening
- Document licensed provider oversight and technician supervision for any administration/scoring performed by non-licensed staff
Definitions
Background
Neuropsychological assessments measure behavioral manifestations of central nervous system (CNS) disorders using objective, valid, and reliable techniques. Results from these assessments inform medical decisions by providing data relevant to diagnosis, prognosis, assessment of disease course or progression, and treatment planning. Psychological assessment involves systematic collection of reliable information about behavior from multiple sources to inform diagnosis, treatment planning, or treatment evaluation; both types of assessment require standardized tests and interpretation within the clinical context.
Revision History and Policy Changes
Initial policy version published establishing coverage and coding rules for psychological and neuropsychological testing and evaluation services (POL-PP-261).
Psychiatrist added to list of providers authorized to bill psychological and neuropsychological testing.
Corrected a transposed CPT code in the policy coding section.
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