Billing Guide for Psychological Screening and Testing ...

1 Billing Guide for Psychological Screening and Testing - 2022 Quick ReferenceTypePerformedByCodeConditionsMi nimumTimeAllowableTelemedUsableAudioOnly ScreeningAny961271-2NA$ +16 Minutes$ 2023 YesTestAdministrationTechnician961382+16 Minutes$ 2023 YesTest EvaluationProvider961301+31 Minutes$ 2023 YesScreeningMental Health Screening is the attempt to detect mental health symptoms in a large number of apparently healthyindividuals. This can be done in many different ways from paper-based instruments in the exam room, tocomputer-based Screening in the waiting room, to physician interviews during a routine exam. The goal is to evenly applythe Screening process to as many patients as possible in order to identify the largest number of individuals suffering frommental health CodesCode:CMS Definition:Recommended Fee Schedule:CPT 96127 Briefemotional/behavioral assessment with scoringanddocumentation, per standardized Medicare allowable of: $ charge of: $20 Note:Most insurances allow the 96127 CPT code to be billed up to4 times per yearwith up to2 sure if multiple screenings are run, CPT code 96127 is on the CMS form only 1 time.

2 Theadditional screenings are added to the units section of the CMS line; 1 unit for each insurance, including medicare, will not allow the use of 96127 in addition to CPT 96130 codes:Medicare:Medicare requires the use of G0444 ratherthan 96127 if Screening during the annualwellness visit, and should be justified with the annual wellness ICD-10 code. 96127 may be used forscreening at any other Medical:Most insurance companies require thegeneric Screening ICD-10 AdministrationOnce the potential for a mental health condition has been established by either Screening or the presence of a comorbidcondition, Testing is used to determine the presence or absence of that mental health condition.

3 For the purpose ofbilling, test administration requires medical necessity and must be justified by a related ICD-10 code. Testadministration can be performed by either a physician or qualified healthcare professional, or a technician under thesupervision of a physician or qualified healthcare professional,using the method allowed for each Administration CodesCode type:CMS Definition:Recommended Fee Schedule:CPT 96136 Psychological or neuropsychological test administrationand scoring byphysicianor other qualified healthcareprofessional,two or more tests,any method, : For each additional 30 minutes use CPT code Medicare allowable of: $ charge of.

4 $110 CPT 96138 Psychological or neuropsychological test administrationand scoring bytechnician,two or more tests,anymethod; first 30 : For each additional 30 minutes use CPT code Medicare allowable of: $ charge of: $90 CPT 96146 Psychological or neuropsychological test administration,withsingleautomated instrumentvia electronic platform,with automated Medicare allowable of: $ charge of: $10 ICD10 codesMedicare:Medicare requires mental health relatedICD10 codes (codes beginning in F) or codes forconditions/ symptoms comorbid to mental health conditions - refer to the latest Medicare Billingand CodingArticlesfor the exact covered Medical:Depending on the specific coveragefor mental health in a patient s plan there are 2approaches to choosing ICD-10 the Billing provider is a behavioral health provider and/ or the plan covers mental health,then bill using mental health related ICD10 codes (codes beginning in F).

5 The Billing provider is NOT a behavioral health provider and/ or the plan does not covermental health, bill using ICD10 codes for conditions/ symptoms comorbid to mental example, depression and anxiety are comorbid to diabetes, and it is the standard of careto test for both when treating diabetes. The ICD10 code for diabetes should justify theadministration in most to Non-behavioral health providers:Most commercialinsurance companies separate theirbehavioral health claims. If the mental health tests were used to determine whether or not mentalhealth was affecting the physical health of the patient, the claim should be processed by thephysical medicine side.

6 ICD10 codes related to physical medicine can avoid the complexitiesgenerated by behavioral health Evaluation ServicesTest evaluation services are designed to cover the physician or qualified healthcare professional s time in evaluating theresults of a patient's mental health tests and determining a plan of Evaluation CodesCode type:CMS Definition:Recommended Fee Schedule:CPT 96130 Psychological Testing evaluation services byphysicianorother qualified healthcare professional, includingintegration of patient data, interpretation of standardizedtestresultsand clinical data, clinicaldecisionmaking,treatmentplanning andreport, and interactivefeedbackto the patient, family member(s) or caregiver(s), whenperformed.

7 First hourNote: For each additional one-hour use CPT code Medicare allowable of: $ charge of: $275 ICD10 codes:Medicare:Medicare requires mental health relatedICD10 codes (codes beginning in F) or codes forconditions/ symptoms comorbid to mental health conditions - refer to the latest Medicare Billing andCodingArticlesfor the exact covered Medical:Depending on the specific coveragefor mental health in a patient s plan there are 2approaches to choosing ICD-10 the Billing provider is a behavioral health provider and/ or the plan covers mental health,then bill using mental health related ICD10 codes (codes beginning in F). the Billing provider is NOT a behavioral health provider and/ or the plan does not covermental health, bill using ICD10 codes for conditions/ symptoms comorbid to mental health.

8 Forexample, depression and anxiety are comorbid to diabetes, and it is the standard of care to testfor both when treating diabetes. The ICD10 code for diabetes should justify the administrationin most to Non-behavioral health providers:Most commercialinsurance companies separate theirbehavioral health claims. If the mental health tests were used to determine whether or not mentalhealth was affecting the physical health of the patient, the claim should be processed by the physicalmedicine side. ICD10 codes related to physical medicine can avoid the complexities generated bybehavioral health Billable CodesAdditional billable services are available below that cover codes for Medicare and Medicaid annual wellness visits, andannual substance use -MedicareH0049 -MedicaidAlcohol and/or substance use (other than tobacco) screeningand brief intervention services,between 15-30 minutesNote: May use up to once per yearAverage Medicare allowable of: $18 Recommended charge of: $50G codes forMedicareG0444 (96127)See 96127 AboveICD10 codes.

9 Use the ICD10 code for the annual wellness GuidelinesNCCI - 2021 The psychiatric diagnostic interview examination (CPT codes 90791, 90792), Psychological /neuropsychological Testing (CPT codes 96136-96146), and Psychological / neuropsychological evaluationservices (CPT codes 96130-96133)must be distinctservicesif reported on the same date of service."CPT Manual" instructions permit physicians to integrate other sources of clinical data into the reportthat is generated for CPT codes 96130-96133. Since the procedures described by CPT codes96130-96139 are timed procedures, physiciansshallnot report time for duplicating information(collection or interpretation) included in the psychiatric diagnostic interview examination and/orpsychological/ neuropsychological evaluation services or test administration and scoring.

10 (CPT codes96101 and 96118 were deleted January 1, 2019.)Additional Notes: 96127 should not be billed with 96130, 96136, 96138, or 96146 96136 OR 96138 can be billed with 96130 as long as the time for each service is counted separately If time is used to calculate your E&M then it must be separate from the time spent for either 96130, 96136, or96138 When determining if time was met for a timed code, you must have at least 1/2 of the code time plus 1 example a 30 minute code like 96136 or 96138 would require at least 16 minutes of total time administeringa test, confirming answers, etc. in order to Only: You cannot bill 90792 along with 96130, 96136, or 96138, as they are essentially for the same services.