New psychological testing codes

[Melisacannon]

Can someone please tell me how to bill these new codes? 96130; 96131; 96136; 96137
Do I bill them all together on the last date of service? Or if the patient is seen on several dates - can I bill them all multiple times? Also, does anyone have any info on how many units are being accepted per insurance company?

Thank you!

 

[CodingKing]

APA suggests billing on the last date if possible

https://www.apaservices.org/practice/reimbursement/health-codes/testing-code-faq.pdf

How should we bill for services that take place over multiple days?


It is typical for psychologists to provide Testing Evaluation Services 96130-96133 and/or Test
Administration and Scoring services 96136-96139 across multiple dates of service. This could
include multiple testing sessions with test scoring, non-face to face time engaged in professional
services, and interactive feedback sessions. When a service is spread out over multiple visits, it is
recommended that all codes be billed together on the last date of service when the evaluation
process is completed. Additionally, a base code should only be submitted for the first unit of
service of the evaluation process, and only add-on codes be used to capture the services provided
during subsequent days of service.


If an institution, agency, or practice requires that a bill be submitted prior to completion of the
entire evaluation process, then it is recommended that a note be submitted on the date of each
service that indicates the number of hours of service provided and billed on that day “with
evaluation ongoing and report to follow”. Final report documentation should include all dates
billed corresponding to services provided.

 

[Melisacannon]

APA suggests billing on the last date if possible

https://www.apaservices.org/practice/reimbursement/health-codes/testing-code-faq.pdf

Thank you so much for your reply. I just want to make sure I am understanding correctly. I have provided an example below. Also, when it comes to collecting a copay, should we only collect one if we are billing everything on the same date?

Here's what one of my evals looks like for my billing log. This typically would've been 13 units of 96101.

1/4/2019 SAMPLE PATIENT 96130
1/4/2019 SAMPLE PATIENT 96131 (8)
1/4/2019 SAMPLE PATIENT 96136
1/4/2019 SAMPLE PATIENT 96137 (7)

Here 90791 was billed on a separate day and her feedback will be billed later.

 

[0383806]

modifiers

obvisouly no modifiers on the add on codes but what about the intital codes?

 

[Cmcgoldrick]

Pricing

Has anyone had any luck finding pricing for the new psych testing codes?

 

[mccormickb1]

new psychological evaluation codes 96130/31 be used along with new developmental test

For very young children when the team does and psychological evaluation the will perform developmental testing (new codes 96112/13), they also are gathering clinical data, history etc. Can they use the 96130/96131 for the integration,clinical data collection ( including the developmental testing results), clinical decision making and providing feedback with recommendations to the family? So we would bill 96112/96113 for the testing and 96130/96130 for the rest?

 

[Carolyn Lammle]

Thank you so much for your reply. I just want to make sure I am understanding correctly. I have provided an example below. Also, when it comes to collecting a copay, should we only collect one if we are billing everything on the same date?

Here's what one of my evals looks like for my billing log. This typically would've been 13 units of 96101.

1/4/2019 SAMPLE PATIENT 96130
1/4/2019 SAMPLE PATIENT 96131 (8)
1/4/2019 SAMPLE PATIENT 96136
1/4/2019 SAMPLE PATIENT 96137 (7)

Here 90791 was billed on a separate day and her feedback will be billed later.

Wondering if you 're getting paid on the testing? Are you using 'units' or should I use a modifier? I'm getting rejections either way... so now I'm confused! Thanks!