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Updates to codes for central nervous system assessments and tests
November 30, 2018

This article is for pediatricians and neurologists

The codes you use to bill for certain central nervous system tests and screenings will change on January 1, 2019. These include psychological and neuropsychological testing, aphasia, cognitive performance, and developmental and behavioral testing and screening services.

Prior authorization requirements are not changing

  • We will continue to require prior authorization for the following services:
    • Neuropsychological testing evaluation
    • Psychological testing evaluation

The Mass Collaborative will be updating this form that is used to request require prior authorization for these services:
Psychological and neuropsychological assessment supplemental form

  • If your patient has a current authorization for neuropsychological testing services, we don’t require a new authorization for these codes. When reauthorization is required, please use the new CPT codes to request it.
  • Codes for testing of aphasia, cognitive performance, and developmental/behavioral testing and screening 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.

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.