Question CPT 96130 -- Provider types allowed to bill

rclark11

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Newtonia, MO
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Hello,

I have bills from a provider, billed by the MD, for service code 96130, but the services are being performed by PT's an ACU's. In the description below, what provider types are considered to be "other qualified health care professional? Can CPT 96130 be performed and billed by PT's and ACU's?

CPT 96130 - Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour.

thank you
 

AmandaBriggs

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Coeur d'Alene, Idaho
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There is a CMS NCD for these services and they expect the service to be performed by a physician or a non-physician such as a clinical psychologist, independent psychologist, nurse practitioner, clinical nurse specialist, or physician assistant. The service can also be performed by a technician under the clinician's direct supervision. The service must be within the scope of their clinical practice/education.

Article - Billing and Coding: Psychological and Neuropsychological Testing (A57481)
 
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