What is CPT code 96136 and its reimbursement requirements?

CPT 96136 is a healthcare procedural code used by healthcare professionals to report psychological and neuropsychological tests and assessments. Specifically, CPT code 96136 is used to report the administration and interpretation of the psychological or neuropsychological test(s) that require integration of the data obtained from multiple sources, such as psychological tests, interviews, and observations of behavior.

This is a 30-minute time-based code. To qualify as 30 minutes, when billing CPT 96136, the time must be a minimum of 16 minutes, and includes the total time administering and scoring the test.

To bill for psychological or neuropsychological testing using CPT code 96136, the following steps should be taken:

1. Verify insurance coverage: Before administering the test, you should verify the patient's insurance coverage for psychological or neuropsychological testing. This will help ensure that the test is covered by the patient's insurance plan and will also help you determine any potential out-of-pocket costs for the patient.
2. Administer the test: Administer the psychological or neuropsychological test(s) to the patient. This may involve a combination of written tests, interviews, and observations of behavior.
3. Document the results: Once the test is complete, document the results in the patient's medical record. This should include a description of the tests administered, the patient's performance on the tests, and any additional observations or notes.
4. Choose the appropriate CPT code: Determine which CPT code(s) should be used to bill for the testing services. In this case, you would use CPT code 96136 to report the administration and interpretation of the psychological or neuropsychological test(s).
5. Submit the claim: Submit the claim to the patient's insurance company using the appropriate billing codes and any required documentation, such as the results of the test and the patient's medical record. The insurance company will then process the claim and determine the amount of coverage for the services provided.

It is important to note that billing for psychological or neuropsychological testing can be complex, and it is important to ensure that all billing codes and documentation are accurate and complete to avoid claim denials or delays. It may be helpful to consult with a billing specialist or other healthcare professional familiar with insurance billing requirements to ensure that you are billing correctly.

Please note that Creyos can not determine your eligibility for reimbursement and does not assume responsibility over the outcome of any claims. The selection of CPT codes noted to report the services provided will depend on other procedures performed, associated CCI edits, and other factors.

Please contact your local payer to determine whether you qualify for these codes, and if any additional coding and coverage guidelines exist, such as which providers can perform the service, limits on billable time, or if the use of a modifier is required or allowed.