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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 9 Physician : 9.2 Services, Benefits, Limitations, and Prior Authorization : 9.2.25 Developmental and Neurological Assessment and Testing : Neurobehavioral Testing
A neurobehavioral examination (procedure code 96116) is a benefit of Texas Medicaid only when a medical or psychiatric diagnosis exists that establishes the need for a detailed evaluation of neurological impairment. Neurobehavioral testing is not medically necessary if a clinical interview alone would provide all the necessary diagnostic information.
Neurobehavioral testing is limited to the diagnosis codes listed in the following table:
Testing performed for other diagnoses constitute screening and are not covered by Texas Medicaid. Documentation maintained in the client’s medical record must support medical necessity for each test performed.
Procedure code 96116 is limited to four hours per day and eight hours per calendar year, any provider.
Providers must bill the preponderance of each half hour of neurobehavioral testing and indicate that number of units on the claim form.

Texas Medicaid & Healthcare Partnership
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