Practice Directorate Gains Increased Medicare Payments for Testing Services in 2006
by Federal Regulatory Affairs and Communications Staff
November 8, 2005 -- Medicare has just announced increased payments for psychological and neuropsychological testing services, effective Jan. 1, 2006. The historic revision in the Medicare fee schedule resulted from a decade of advocacy by the Practice Directorate.
Also, on Jan. 1, Medicare will require the use of an expanded set of testing service Current Procedural Terminology (CPT)® codes that replace the existing codes in effect through Dec. 31, 2005. The revised psychological and neuropsychological testing codes will reflect whether a psychologist, a technician or a computer does the testing.
The chart below reflects the estimated changes in payments as well as the revised code numbers that apply to outpatient as well as hospital/facility settings. (See related article, "2006 Medicare Fee Schedule: Reversal of 4.4% Payment Reduction Expected Soon.")
ESTIMATED MEDICARE FEE INCREASES AND CODE CHANGES FOR 2006 TESTING SERVICES
1. Outpatient Settings: 2006 Estimated Average Medicare Payments for Testing Services
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PSYCHOLOGICAL ASSESSMENT: |
| | | | | | New 2006 CPT Code | Conducted by | 2006 Code Payment/Hr | 2005 Code | 2005 Code Payment/Hr | | 96101 | Psychologist | $92.61 | 96100 | $73.52 | | 96102 | Technician | $42.33 | N/A | N/A | | 96103 | Computer | $26.77 (flat fee) | N/A | N/A |
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NEUROPSYCHOLOGICAL ASSESSMENT: |
| | | | | | New 2006 CPT Code | Conducted by | 2006 Code Payment/Hr | 2005 Code | 2005 Code Payment/Hr | | 96116 | Neurobehavioral Status Exam | $103.83 | 96115 | $73.52 | | 96118 | Psychologist | $124.09 | 96117 | $73.52 | | 96119 | Technician | $63.31 | N/A | N/A | | 96120 | Computer | $45.94 (flat fee) | N/A | N/A |
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2. Facility/Hospital Settings: 2006 Estimated Average Medicare Payments for Testing Services
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PSYCHOLOGICAL ASSESSMENT: |
| | | | | | New 2006 CPT Code | Conducted by | 2006 Code Payment/Hr | 2005 Code | 2005 Code Payment/Hr | | 96101 | Psychologist | $91.89 | 96100 | $73.52 | | 96102 | Technician | $24.60 | N/A | N/A | | 96103 | Computer | $23.52 (flat fee) | N/A | N/A |
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NEUROPSYCHOLOGICAL ASSESSMENT: |
| | | | | | New 2006 CPT Code | Conducted by | 2006 Code Payment/Hr | 2005 Code | 2005 Code Payment/Hr | | 96116 | Neurobehavioral Status Exam | $96.95 | 96115 | $73.52 | | 96118 | Psychologist | $96.59 | 96117 | $73.52 | | 96119 | Technician | $33.28 | N/A | N/A | | 96120 | Computer | $25.32 (flat fee) | N/A | N/A |
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(NOTE: All fees for 2006 reflect Medicare's scheduled payment reductions of 4.4 percent. See related article, "2006 Medicare Fee Schedule: Reversal of 4.4% Payment Reduction Expected Soon.")
The federal Centers for Medicare and Medicaid Services (CMS) sets the final fee schedule for all CPT codes in Medicare. For the first time, CMS agreed with the Practice Directorate and the American Medical Association (AMA)/Specialty Society Reimbursement Committee that psychologists’ reimbursement for testing services should include a “professional work value.” Until now, a psychologist’s professional time and effort in providing testing services was not captured in the Medicare fee schedule.
While the reimbursement committee also concurred with the Practice Directorate’s recommendation that CMS assign higher work values for neuropsychological assessment services compared to psychological assessment services, the federal agency did not accept the recommendation and assigned the same work values for both psychological and neuropsychological assessment.
The revised code numbers and payment levels apply to Medicare effective Jan. 1. As they often do, private insurance carriers may soon follow Medicare’s lead.
Practitioners must use the existing testing codes for Medicare through Dec. 31, 2005, and begin using the revised codes starting Jan. 1, 2006. Psychologists, their office staffs and their billing agents should be prepared in advance to make the switch to the revised codes on Jan. 1.
Anyone with questions should call the Practice Directorate’s government relations department at (202) 336-5889 or email pracgovt@apa.org. Additional information about proper use of the testing codes is included in the article at APApractice.org, “Questions and Answers About the 2006 Revised CPT Testing Codes.”
The new code numbers are published in CPT 2006©, which is now available from the AMA at 1-800-621-8335.
Current Procedural Terminology ©2005 American Medical Association. All Rights Reserved.
