HealthCare News

Psychological and Neuropsychological Testing Update – Professional Claims Only

Issue: #410 SEP2019

Topic: Reimbursement


Blue Cross Blue Shield of North Dakota (BCBSND) has reviewed guidance from the American Medical Association (AMA) and the Centers for Medicare and Medicaid Services (CMS) related to the allowable practitioners and Medically Unlikely Edit (MUE) values for the Psychological and Neuropsychological Testing CPT codes.

The publication of the 2019 CPT Manual by the AMA added “Other Qualified Healthcare Professional” within the code description. To address this additional eligible provider, BCBSND updated the two codes below to allow psychologists to perform the following services:

  • 96116 – Neurobehavioral status examination by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; first hour
  • 96121 – Neurobehavioral status examination by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; each additional hour

BCBSND reviewed clinical documentation and standards of practice for these services. The findings supported the change in the MUE values associated with the two CPT codes below. The MUEs for 96137 and 96139 were increased from 11 units to 17 units with an effective date of January 1, 2019.

  • 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 minutes
  • 96139 – Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; each additional 30 minutes

Due to the above MUE changes, BCBSND has revised the Correct Coding Guidelines and MUE Revisions Addendum available at https://www.bcbsndreimbursementpolicy.com/.