Cpt 96103 - Clinical Social Worker

celcano

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We are a Pain Management clinic(private physician practice) and recently hired a Licensed Clinical Social Worker. However, I have a question about billing for her psych testing. She wanted to bill a 96103 for her psych testing, but I told her she could not because the test is not administered by a computer. She told me it was the same type of test administered by a computer, but was just done with a paper and pencil. So, I went on a search to see if there would be a code I could bill. It looked like I was in the 96101-96103 area. However, I don't know if it would be appropriate to use one of these either.

96101 – Psychological testing, per hour of the psychologist’s or physician’s time, both face-to-face time administering tests of the patient and time interpreting these test results and preparing the report. I asked Noridian Medicare this question, and they could not answer it. This code reads psychologist’s or physician’s time. Since she is a LCSW, this code does not seem appropriate to me.

96102 – Psycholotical testing with qualified health care professional interpretation and report, administered by technician, per hour of technician time, face-to-face
Some thought since the LCSW was administering the test, she could use this as there is no real definition of a technician. Obviously, the LCSW has the licensing to do this, but she is not a technician. Would it be appropriate for the LCSW to administer the test and render the interp/report and bill by the total time she spent?

Any assistance you can rendered would be greatly appreciated.
 

CodingKing

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I was looking at one of the LCD's and did not see anything indicating a LCSW can bill for psychological testing it just mentions NP, PA, Psychologist, MD. Its been 10 years but back when I worked in the Behavioral Health department at a commercial payer and we would never authorize anyone but a Psychologist or Psychiatrist for this service (things may have changed). I think the bigger issue would be is psychological testing covered for someone not showing signs or symptoms of mental illness.
 
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celcano

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Thank you for you input. This was what I was thinking, but did not want to leave money on the table.
 
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