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December 2016 Texas Medicaid Provider Procedures Manual

Behavioral Health, Rehabilitation, and Case Management Services Handbook : 6 Physician, Psychologist, and Licensed Psychological Associate (LPA) Providers : 6.11 Psychological and Neuropsychological Testing : 6.11.3 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.
Reimbursement for the psychological and neuropsychological testing (procedure codes 96101 and 96118) include both the time spent during face-to-face testing with the client and the time spent scoring and interpreting the results. If the scoring and interpretation are performed on a different date of service from the testing, then the date of service on the claim must reflect the date and time spent for each service performed. Even if scoring and interpretation are completed on a different date from the testing, providers must submit only one claim for each psychological or neuropsychological test performed. If necessary, providers can submit the claim with multiple details for each date of service.
The correct modifier AH, UC, or U9 must be appended to the procedure code to identify who rendered the service. If the LPA, PLP, 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 or visit procedure 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.
Psychological or neuropsychological testing may be reimbursed on the same date of service as an initial psychiatric diagnostic evaluation or interactive psychiatric diagnostic evaluation.
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.

Texas Medicaid & Healthcare Partnership
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