Neuropsychological and Psychological Evaluation Current Procedural Terminology (CPT) 2019 updates
Date: 01/22/19
Heritage Health (Medicaid):
Nebraska Total Care will align with Nebraska Medicaid Provider Bulletin PB 19-04 (PDF) related to CPT code changes for these identified services.
Nebraska Total Care is working to update our systems to this new code structure and we have an expected effective date of February 18, 2019 for the new code structure.
Below are tables that identify:
- Procedure code
- Definition
- Prior authorization requirement
- Reimbursement rates
| Procedure Code | Definition | Prior Authorization |
|---|---|---|
| 96116 | Neurobehavioral status exam by physician or other qualified health care professional, both face-to-face with the patient, and time interpreting test results and preparing the report, first hour only. | No |
| 96121 | Each additional hour for the Neurobehavioral status exam. | No |
| 96130 | Psychological testing evaluation service 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 members or caregivers, when performed, first hour. | Yes |
| 96131 | Each additional hour for the psychological testing evaluation service. | Yes |
| 96132 | Neuropsychological 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, or caregiver, when performed, first hour. | Yes |
| 96133 | Each additional hour for the Neuropsychological testing evaluation service. | Yes |
| 96136 | Psychological or neuropsychological test administration and scoring by a physician or other qualified health care professional. Two or more tests, any method, first 30 minutes. | Yes |
| 96137 | Each additional 30 minutes for the psychological or neuropsychological test administered by physician. | Yes |
| 96138 | Psychological or neuropsychological test administration and scoring by technicians. Two or more tests, any method, first 30 minutes. | Yes |
| 96139 | Each additional 30 minutes for the psychological or neuropsychological test administration by technician. | Yes |
| Procedure Code | 1st Hour | Each Additional Hour | 1st 30 Minutes | Each Additional 30 Minutes |
|---|---|---|---|---|
| 96116 | $184.69 | |||
| 96121 | $101.85 | |||
| 96130 | $184.69 | |||
| 96131 | $101.85 | |||
| 96132 | $184.69 | |||
| 96133 | $101.85 | |||
| 96136 | $101.85 | |||
| 96137 | $47.53 | |||
| 96138 | $101.85 | |||
| 96139 | $47.53 |
The updated pre-authorization requirements will be reflected in our pre-authorization check tool to verify authorization is needed. When using this tool please ensure you select the appropriate service domain for authorization verification (Radiology, Physical Health, Behavioral Health or PT/OT/ST) and fill out the questions in the tool completely to verify authorization requirement.
If you have questions, please contact Provider Relations.