Philips has developed IntelliSpace Cognition (ISC), a fast and reliable digital platform that can help neurologists administer well-established assessments and inform diagnosis. Treatment can then be established with a robust understanding of patient cognition.
Current Procedural Terminology (CPT) codes give neurology and neuropsychology practices the flexibility to bill for technician or physician assessment administration, distinct from the subsequent clinician time spent on interpretation and treatment planning. These changes, combined with innovations such as ISC, can enable a medical assistant or other staff member to administer assessments reliably and improve patient evaluations, which may help neurologists to better evaluate and treat more patients.*
In fact, early customer experience indicates that a combination of CPT codes 96138-96139 and 96132-96133 can be used to bill for the technician administration of cognitive assessments and subsequent neurologist interpretation and treatment planning, which can occur on the same or separate days as administration of assessments.*,†,2 Potential variations in administration and interpretation times will affect the combination of CPT codes billed.1,3,4
CPT code: 96132
Code description: Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s). When performed; first hour.
2019 Medicare national average payment rate1: $133.71
CPT code: 96133
Code description: Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s). When performed; each additional hour (list separately in addition to code for primary procedure.
2019 Medicare national average payment rate1: $101.99
CPT code: 96136
Code description: Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional. Two or more tests, any method, first 30 min.
2019 Medicare national average payment rate1: $47.93
CPT code: 96137
Code description: Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional. Two or more tests, any method, each additional 30 min. (list separately in addition to code for primary procedure).
2019 Medicare national average payment rate1: $44.33
CPT code: 96138
Code description: Psychological or neuropsychological test administration and scoring by technician. Two or more tests, any method, first 30 min.
2019 Medicare national average payment rate1: $38.92
CPT code: 96139
Code description: Psychological or neuropsychological test administration and scoring by technician. Two or more tests, any method, each additional 30 min. (list separately in addition to code for primary procedure.
2019 Medicare national average payment rate1: $38.92
*Market research performed by Boston Healthcare Associates. The information provided is intended to assist providers in determining appropriate codes and reimbursement purposes. It represents the information available in the public domain as of the date listed in this document. It is the provider’s responsibility to determine and submit appropriate codes, modifiers, and claims for the services rendered. Before filing any claims, providers should verify current requirements and policies with the applicable payer. Philips makes no guarantees concerning reimbursement or coverage.
†Actual payment rates may vary by geographic region and specific practices; therefore, actual payment rates may differ from those reflected in the table above, which depicts the 2019 Medicare national average payment rates.
1 “CMS-1693-F.” Centers for Medicare & Medicaid Services, 23 Nov. 2018, www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1693-F.html.
2 “Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; Medicaid Promoting Interoperability Program; Quality Payment Program-Extreme and Uncontrollable Circumstance Policy for the 2019 MIPS Payment Year; Provisions From the Medicare Shared Savings Program-Accountable Care Organizations-Pathways to Success; and Expanding the Use of Telehealth Services for the Treatment of Opioid Use Disorder Under the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act.” Federal Register, 23 Nov. 2018, www.federalregister.gov/documents/2018/11/23/2018-24170/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other-revisions.
3 “Getting Reimbursed: Testing Code Changes Are Here.” American Psychological Association, www.apaservices.org/practice/reimbursement/health-codes/testing/code-changes.
4 “Up to Code: Testing Code Changes Are Here.” American Psychological Association, www.apaservices.org/practice/reimbursement/health-codes/testing/changes.
