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Psychological and neuropsychological testing codes being updated
November 30, 2018

This article is for behavioral health hospitals and facilities, child psychiatrists, clinical psychologists, community mental health centers, opioid treatment centers, psychiatrists, and psychiatrist/neurologists.

We recently posted a News Alert for behavioral health providers with updates to the codes you use to bill for central nervous system assessments and tests (including psychological and neuropsychological testing services) that will take effect on January 1, 2019. To read your News Alert, log in and go to News>Claims, Coding, Payment and scroll to the News Alert dated November 30, 2018.

Prior authorization requirements are not changing

  • We will continue to require prior authorization for the following services:
    • Neuropsychological testing evaluation
    • Psychological testing evaluation
  • If you have a current authorization for neuropsychological testing services, you don’t need to obtain a new authorization for these codes. When reauthorization is required, please request reauthorization using the new CPT codes.
  • The rest of the central nervous system testing codes will continue to have no prior authorization requirements. However, we plan to monitor these codes in 2019 and reevaluate the need for authorizations for 2020.

Key documents will be updated
We are currently preparing to update our Behavioral Health and Substance Use payment policy and your fee schedule prior to January 1, 2019. Please review these documents prior to billing for services effective January 1, 2019. This will reduce your claim denials and appeals. To view your fee schedule, log in and go to Office Resources>Billing and Reimbursement> Fee schedules.

In addition, the Mass Collaborative will be updating this form:

Familiarize yourself with coding standards
The new CPT codes require that you familiarize yourself with two coding standards:

  • Billing for time-based codes. When billing for time-based codes, patient care must be provided for at least 50% of the time unit. In other words, a provider may only bill for services measured in 30-minute increments if they have provided 16 minutes of service.
  • Billing for stand-alone and add-on codes. The new codes include stand-alone codes that describe the initial hour of test evaluation or initial half hour for test administration, as well as add-on codes that describe additional work and time associated with those services. Add-on codes are never reported as stand-alone codes and must always be reported in conjunction with the primary or base service.

Important: Your claim submission should reflect the date the service was rendered, rather than bundling all CPT codes on a single date.

Please refer to your professional association’s website and other communications for more information about appropriate coding.