Cognitive assessment reimbursement

Cognitive assessment

Cognitive assessment reimbursement can give neurology practices more flexibility 

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CPT codes can support the introduction of cognitive assessment into your practice

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

Code description

2019 Medicare national average payment rates.1

Interpretation & Treatment Planning

Interpretation & treatment planning

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

96132
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.
$133.71
96133
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.
$101.99
Administration & Scoring

Administration & scoring

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

96136
Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional. Two or more tests, any method, first 30 min.
$47.93
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 min. (list separately in addition to code for primary procedure).
$44.33
96138
Psychological or neuropsychological test administration and scoring by technician. Two or more tests, any method, first 30 min.
$38.92
96139
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.
$38.92
Source: Medicare 2019 Physician Fee Schedule
Administration of cognitive assessment
Time Intervals
CPT Code(s)²
16-45 min
96138
46-75 min
96138 + 96139
76-105 min
96138 + (96139 × 2)
106-135 min
96138 + (96139 × 3)
For time-based codes, a unit of time is attained when the mid-point is passed– thus, for 30 minute interval codes a minimum of 16 minutes must have passed in order to bill the codes3,4
Sources: APA, "Getting Reimbursed: Testing Code Changes are Here"; APA, "Up to Code: Testing Code Changes are Here"
Interpretation of cognitive assessment
Time Intervals
CPT Code(s)²
31-90 min
96132
91-150 min
96132 + 96133
151-210 min
96132 + (96133 × 2)
211-270 min
96132 + (96133 × 3)
For time-based codes, a unit of time is attained when the mid-point is passed– thus, for 1 hour interval codes, 31 min need to have passed to bill the codes3,4
Sources: APA, "Getting Reimbursed: Testing Code Changes are Here"; APA, "Up to Code: Testing Code Changes are Here"

Philips IntelliSpace Cognition (ISC):

 
  • Empowers neurologists to reliably and efficiently administer robust computerized cognitive assessments
  • Directs insights into cognitive performance
  • Tracks cognitive performance over time

More articles

  • Advancing Digital Technologies for Rapid and Reliable Cognitive Assessment

    Advancing Digital Technologies for Rapid and Reliable Cognitive Assessment

    Learn more
  • IntelliSpace Cognition is more than a cognitive screener

    IntelliSpace Cognition is more than a cognitive screener

    Learn more

Footnotes

 
*
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.

References

 

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.