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7.11.3 Reimbursement
Psychological (procedure code 96101) and neuropsychological (procedure code 96118) testing is limited to a total of four hours per day, and eight hours per client per calendar year for any provider. Hours billed beyond four hours per day will be denied without prior authorization. All supporting documentation must be maintained by the provider in the client's medical record.
Claims for psychological and neuropsychological testing may be reimbursed for both the face-to-face time spent administering the test and the time spent scoring and interpreting the test.
If the administration, interpretation, and scoring of a test occurs over more than one date of service, providers must bill the services on a single claim and must use a separate detail for each date of service.
Claims must not be submitted until the administration, interpretation, and scoring of the test has been completed.
The correct modifier AH or UC must be appended to the code to identify who rendered the service. If both the LPA and psychologist perform services on the same date one detail must be submitted for each provider with each detail accurately representing the time spent by the psychologist or LPA. Time billed for services performed on the same client must not be billed for the same time and date of service.
Services provided by both the psychologist and LPA count toward the total four hours of testing allowed per client per day.
Psychological and neuropsychological testing will not be reimbursed to a CNS, NP, or a PA. Behavioral health testing may be performed during an assessment by a CNS, NP, or a PA, but will not be reimbursed separately. The most appropriate office encounter/visit code must be billed. Behavioral health testing performed by a CNS, NP, or a PA during an assessment will be denied as part of another service when billed.
Psychological or neuropsychological testing may be reimbursed on the same date of service as an initial diagnostic interview or interactive psychiatric diagnostic interview examination. Psychological testing performed on the same date of service as neuropsychological testing will be denied as part of another service. All documentation must be maintained by the provider in the client's medical record.
Psychological or neuropsychological testing may be reimbursed on the same date of service as an initial psychiatric diagnostic interview or interactive psychiatric diagnostic interview examination.
Psychological testing performed on the same date of service as neuropsychological testing will be denied as part of another service. All documentation must be maintained by the provider in the client's medical record.
Providers must bill the preponderance of each half hour of testing and indicate that number of units on the claim form.
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