2006 Revised CPT Testing Codes: The Latest News and Information from the APA Practice Directorate
by Federal Regulatory Affairs and Legal and Regulatory Affairs Staff
November 23, 2005 -- In our ongoing efforts to help practitioners be knowledgeable about and make the best use of the revised CPT® testing codes, the Practice Directorate is providing you with this reminder and updated information. The revised CPT codes for psychological and neuropsychological testing will go into effect on January 1, 2006. The new code numbers are available at www.apapractice.org/apo/payments.html#.
The revised codes reflect who does the testing: a psychologist, a technician or a computer. The APA Practice Directorate successfully sought the revised codes as part of a multi-year effort to obtain a “professional work value” for testing and assessment codes. These codes reflect a greater recognition of the value of assessment services provided by psychologists.
Practice Directorate staff have been receiving numerous inquiries about the revised codes, including questions about reimbursement of students and technicians, billing for scoring services, and adoption of the new code numbers by private carriers. Many questions have involved the definition of a technician under the revised codes. We are aware that Division 40 of APA, the American Academy of Clinical Neuropsychology, and the National Academy of Neuropsychology all have policies on the use and training of technicians, and define administration and scoring as appropriate roles for them. However, it should be noted that under the revised CPT codes, scoring is not a billable activity, unless it is done while the technician is face-to-face with the patient during the test administration.
Below are answers to questions that we have received to date. For more information about using the revised CPT testing codes, please contact the Practice Directorate's Government Relations Department at (202) 336-5889 or by email at Pracgovt@apa.org. Additional information about changes to the codes, billing under the revised codes, and the estimated Medicare fee increases for 2006 testing services is available at APApractice.org.
Q: Do the revised codes allow for students or trainees to administer tests?
A: Yes. To date, there is no specific definition of the term “technician.” Therefore, students’ and trainees’ time spent conducting tests may be billed under the technician-based codes (96102 or 96119).
Q: Can students or other unlicensed individuals interpret and report test results?
A: No. Only a licensed psychologist or other licensed health care professional may bill for time spent on interpretation and reporting psychological and neuropsychological tests.
Q: Is the time that a technician spends scoring tests billable under the technician-based codes?
A: Scoring is not a billable activity unless it is done while the technician is face-to-face with the patient during the test administration.
Q: Will private carriers be ready for the revised codes on January 1, 2006?
A: They should be. HIPAA requires all carriers to update their systems by January 1, 2006.
Q: If a patient takes a paper-and-pencil test, what code should be used?
A: It depends. If a psychologist is with the patient during the test, then that time is allocated to the psychologist code. If a technician provides oversight during the test, then the technician-based code is used. If the patient is entirely on his or her own during the test, that time is not billable.
Q: When is the computer billing code used?
A: The computer code is only used when the patient is alone and taking a computer-based test. Scoring by computer is not a billable activity.
Q: If a patient takes three computerized tests and no one is with him or her, does the psychologist bill the computer code three times?
A: No. The computer code should be billed only once.
Some psychologists have also expressed a concern that private insurance carriers could impose the restriction that they will only pay for technicians to administer tests (thus only reimbursing psychologists for interpreting tests and writing reports). If you become aware of such activity, please alert the Practice Directorate’s Office of Legal & Regulatory Affairs at (202) 336-5886 or by email at praclegal@apa.org. We will be ready to respond to such restrictions should there be any attempt to impose them.
This is one article in a series of communications about the revised 2006 CPT testing codes from the APA Practice Directorate. We will provide additional information about the codes as it becomes available at APApractice.org.
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