Billing and Reimbursement for CPT Code 96146 and related codes (formerly 96103) – Computer-Based Psychological Tests

billing-cpt-96103.jpeg

Computerized psychological testing is a billable event formerly using CPT code 96103.  Many providers have increased revenues, and improved service to patients, by providing this testing service in their clinics.  Almost all insurance companies paid for this service, and in our experience the average reimbursement for CPT code 96103 was between $30 and $75. 

The definition of CPT code 96103 and its requirements were as follows:

Psychological testing (allowing a variety of issues including emotional, intellectual abilities, personality, psychopathology, MMPI, etc.), administered by a computer.  Includes interpretation and report by a qualified health professional.  This does not have to be a psychiatrist, psychologist, or other behavioral health specialist.  It can be a primary care physician, specialty physician, or mid-level being supervised by a physician.  This 96103 CPT code is not a time-based code and is only used once per session. 

When done properly, billing for the set of CPT codes that replaced 96103 has a very high success rate, and our clients see significant increases in revenue.
— Jonathan Marshall, President of RPM Billing LLC

However, in 2019 CPT code 96103 was discontinued and it was replaced by an expanded set of CPT codes. We help our clients navigate these situations and create efficient processes in the clinic that result in higher payment outcomes. The new CPT codes are as follows:

96136    Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes    

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 (List separately in addition to code for primary procedure)    

96138    Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes    

96139    Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; each additional 30 minutes (List separately in addition to code for primary procedure)    

96146    Psychological or neuropsychological test administration, with single automated, standardized instrument via electronic platform, with automated result only 

97151   Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan     

97152    Behavior identification-supporting assessment, administered by one technician under the direction of a physician or other qualified health care professional, face-to-face with the patient, each 15 minutes    

97153    Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes    

97154    Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with two or more patients, each 15 minutes    

97155    Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes    

97156    Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes    

97157    Multiple-family group adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of guardians/caregivers, each 15 minutes    

97158    Group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, face-to-face with multiple patients, each 15 minutes    

99451    Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient's treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time    

99452    Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes    

99453    Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment    

99454    Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days    

99457    Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month    

99491    Chronic care management services, provided personally by a physician or other qualified health care professional, at least 30 minutes of physician or other qualified health care professional time, per calendar month, with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient; chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; comprehensive care plan established, implemented, revised, or monitored.

To look up the Medicare reimbursement for each CPT Code in your region, click here: https://www.cms.gov/apps/physician-fee-schedule/license-agreement.aspx

Using a conservative approach, the 96146 code would most likely correlate to the former 96103 code. However, the 2018 payment (for Nevada) on 96103 was $28.13 and the 2019 payment (also for Nevada) on 96146 is only $2.16. Several of the new codes also on this document can be billed in addition to 96146 which may result in an overall increase in reimbursement. However, billing for those codes requires additional clinical workflow and documentation to fully support billing for such codes.

It is important that these service line are integrated into medical practices in a way that is efficient in your clinic and helpful to both the patient and the provider.  We are happy to work with our clients and their staff, on-site in their clinics, to identify and implement the simple tweaks needed in order to implement this service.  This requires some staff training, communication, follow-through, and documentation processes.  When this is done properly, collecting on these CPT codes has a very high success rate, and our clients see significant increases in revenue.

RPM Billing is a professional medical billing and consulting firm based in Las Vegas and Reno, Nevada, and serving clients nationwide.  We have helped numerous clients successfully implement strategies such as these.  Led by Jonathan Marshall, a leader with a Healthcare MBA and two decades of experience as CEO, CFO, and COO of hospitals and physician practices, RPM Billing was created as a commitment to excellent processes, results, and customer service for its clients.  To contact us for a free review of your company’s opportunities to improve revenues, call us at 775-501-9820, email us at jon@rpmbilling.com, or visit us at www.rpmbilling.com.