How To Use CPT Code 96125

CPT 96125 refers to standardized cognitive performance testing performed by a qualified healthcare professional, with topics covered in this article including the code description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.

1. What is CPT 96125?

CPT 96125 is a medical billing code used to describe standardized cognitive performance testing performed by a qualified healthcare professional. This testing is used to evaluate a patient’s cognitive function, particularly in cases of memory loss or dementia. The code covers both the face-to-face time spent administering the tests to the patient and the time spent interpreting the test results and preparing the report.

2. 96125 CPT code description

The official description of CPT code 96125 is: “Standardized cognitive performance testing (e.g., Ross Information Processing Assessment) per hour of a qualified health care professional’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report.”

3. Procedure

The 96125 procedure involves the following steps:

1. The qualified healthcare professional selects an appropriate standardized cognitive performance test, such as the Ross Information Processing Assessment.
2. The test is administered to the patient in a face-to-face setting, with the healthcare professional observing and recording the patient’s responses.
3. Upon completion of the test, the healthcare professional interprets the patient’s results, comparing them to established norms and identifying any areas of concern.
4. The healthcare professional prepares a detailed report, summarizing the patient’s performance and providing recommendations for further evaluation or intervention if necessary.

4. Qualifying circumstances

Patients eligible to receive CPT code 96125 services are those who exhibit signs of cognitive impairment, memory loss, or dementia. This may include individuals with a history of traumatic brain injury, neurodegenerative diseases such as Alzheimer’s, or other conditions affecting cognitive function. The testing may also be appropriate for patients experiencing cognitive decline due to aging or other factors.

5. When to use CPT code 96125

It is appropriate to bill the 96125 CPT code when a qualified healthcare professional performs standardized cognitive performance testing on a patient exhibiting signs of cognitive impairment, memory loss, or dementia. The code should be used for each hour of the healthcare professional’s time spent administering the test, interpreting the results, and preparing the report.

6. Documentation requirements

To support a claim for CPT 96125, the following information should be documented:

• Patient’s demographic information, including age, gender, and relevant medical history.
• Reason for referral to cognitive performance testing, including any specific concerns or symptoms reported by the patient or referring provider.
• Details of the standardized cognitive performance test administered, including the name of the test and any modifications made to accommodate the patient’s needs.
• Results of the test, including the patient’s scores and any areas of concern identified during the testing process.
• Interpretation of the test results, including a comparison to established norms and an assessment of the patient’s overall cognitive function.
• Recommendations for further evaluation or intervention, if applicable.
• Total time spent by the healthcare professional administering the test, interpreting the results, and preparing the report.

7. Billing guidelines

When billing for CPT code 96125, it is important to follow established guidelines and rules. These include:

• Ensure that the healthcare professional performing the testing is appropriately qualified and credentialed.
• Bill the code for each hour of the healthcare professional’s time spent administering the test, interpreting the results, and preparing the report.
• Document all required information to support the claim, as outlined in the documentation requirements section.
• Be aware of any payer-specific guidelines or requirements related to billing for cognitive performance testing.

8. Historical information

CPT 96125 was added to the Current Procedural Terminology system on January 1, 2008. There have been no updates to the code since its addition.

9. Similar codes to CPT 96125

Five similar codes to CPT 96125 include:

• CPT 96132: Neuropsychological testing evaluation services by a qualified healthcare professional.
• CPT 96133: Neuropsychological testing evaluation services with the assistance of a technician.
• CPT 96136: Psychological or neuropsychological test administration and scoring by a technician.
• CPT 96137: Psychological or neuropsychological test administration and scoring by a computer.
• CPT 96146: Psychological or neuropsychological test administration with single automated instrument via electronic platform.

These codes differ from CPT 96125 in the specific type of testing performed, the involvement of a technician or computer, and the method of test administration.

10. Examples

Here are 10 detailed examples of CPT code 96125 procedures:

1. A 65-year-old patient with a history of Alzheimer’s disease undergoes the Ross Information Processing Assessment to evaluate their cognitive function and monitor disease progression.
2. A 45-year-old patient with a recent traumatic brain injury is administered a standardized cognitive performance test to assess their memory and cognitive abilities post-injury.
3. A 70-year-old patient experiencing memory loss and difficulty with daily tasks undergoes cognitive performance testing to determine if they have early-stage dementia.
4. A 55-year-old patient with Parkinson’s disease is administered a standardized cognitive performance test to evaluate the impact of the disease on their cognitive function.
5. A 60-year-old patient with a history of stroke undergoes cognitive performance testing to assess their cognitive abilities and identify any areas of concern.
6. A 75-year-old patient with age-related cognitive decline is administered a standardized cognitive performance test to evaluate their memory and cognitive function.
7. A 50-year-old patient with multiple sclerosis undergoes cognitive performance testing to assess the impact of the disease on their cognitive abilities.
8. A 40-year-old patient with a history of brain tumor and subsequent treatment is administered a standardized cognitive performance test to evaluate their cognitive function post-treatment.
9. A 67-year-old patient with a family history of dementia undergoes cognitive performance testing to assess their cognitive function and identify any early signs of cognitive decline.
10. A 72-year-old patient with concerns about memory loss and difficulty with daily tasks is administered a standardized cognitive performance test to evaluate their cognitive abilities and determine if further evaluation or intervention is necessary.