|
38.3.1 Psychological and Neuropsychological Testing
Procedure codes 5-96101 and 1-96118 are covered services for the following diagnoses only:
Psychological testing (procedure code 5-96101) and neuropsychological testing (procedure code 1-96118) are limited to a total of four hours per day and eight hours per calendar year per client for any provider. Providers must maintain documentation in the client's chart that supports the medical necessity for each test.
If the client requires more than four hours of psychological or neuropsychological testing per day or more than eight hours per calendar year, prior authorization is required. Documentation must be submitted that supports the medical necessity for the additional hours requested. This includes a record of all of the tests that were previously performed and a complete history that reflects the need for each requested test.
Each hour of examination, therapy, psychological, and/or neuropsychological testing counts toward the 12-hours-per-day limitation and as one visit/encounter towards the 30 visit/encounter limit.
Procedure codes 5-96101 and 1-96118 include the testing, interpretation, and report and are not reimbursed separately. Providers must bill the preponderance of each quarter hour of testing and indicate that number of units on the claim form. Document the number of hours in Block 24G of the CMS-1500 claim form.
Procedure code 1-96118 is denied when billed on the same day as procedure code 5-96101 by any provider.
Procedure code 5-96101 or 1-96118 is payable on the same day as procedure code 1-90801 or 1-90802.
The following is a list of psychiatric-related procedure codes:
|
