How To Use CPT Code 96136

CPT 96136 refers to the administration and scoring of two or more psychological or neuropsychological tests by a physician or qualified healthcare professional. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 96136.

1. What is CPT 96136?

CPT 96136 is a medical billing code used to describe the administration and scoring of two or more psychological or neuropsychological tests by a physician or other qualified healthcare professional. This code is applicable for the first 30 minutes of test administration and scoring, regardless of the method used. The purpose of these tests is to assess various psychological functions and their relationship to specific brain structures or pathways.

2. 96136 CPT code description

The official description of CPT code 96136 is: “Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes.”

3. Procedure

  1. The provider, a physician or other qualified healthcare professional, explains the tests to the patient, parent, and/or guardian and answers any questions they ask.
  2. He administers the tests by any method. He administers standardized psychological tests including but not limited to personality tests, attitude tests, IQ tests, and achievement tests or neuropsychological tests specifically designed to measure a psychological function known to be linked to a particular brain structure or pathway.
  3. He scores the tests.

4. Qualifying circumstances

Eligibility for CPT code 96136 services is determined by the provider’s qualifications and the patient’s need for psychological or neuropsychological testing. The provider must be a physician or other qualified healthcare professional with the appropriate training and experience in administering and scoring these tests. The patient must have a clinical indication for the testing, such as a suspected cognitive, emotional, or behavioral disorder, or a need for diagnostic clarification or treatment planning.

5. When to use CPT code 96136

It is appropriate to bill the 96136 CPT code when a physician or other qualified healthcare professional administers and scores two or more psychological or neuropsychological tests for the purpose of assessing a patient’s psychological functions and their relationship to specific brain structures or pathways. This code should be used for the first 30 minutes of test administration and scoring, regardless of the method used.

6. Documentation requirements

To support a claim for CPT 96136, the following information should be documented:

  • Patient’s demographic information, including name, date of birth, and insurance information.
  • Referral source and reason for referral, if applicable.
  • Relevant clinical history and presenting concerns.
  • Specific tests administered, including test names, administration methods, and time spent on each test.
  • Test scores and interpretation of results, including any relevant comparisons to normative data.
  • Impressions, diagnoses, and recommendations for further evaluation or treatment, if applicable.

7. Billing guidelines

When billing for CPT code 96136, it is important to follow the appropriate guidelines and rules. Some tips and codes that apply to CPT code 96136 include:

  • Report 96137 with the primary code (96136) for each additional 30 minutes of administration and scoring of psychological or neuropsychological tests.
  • Ensure that the provider administering and scoring the tests is a physician or other qualified healthcare professional with the appropriate training and experience.
  • Document all required information to support the claim, as outlined in the documentation requirements section.

8. Historical information

CPT 96136 was added to the Current Procedural Terminology system on January 1, 2019. There have been no updates to the code since its addition.

9. Similar codes to CPT 96136

Five similar codes to CPT 96136 and how they differentiate from CPT 96136 are:

  1. CPT 96130: This code is used for the first hour of psychological testing evaluation services by a physician or other qualified healthcare professional.
  2. CPT 96131: This code is used for each additional hour of psychological testing evaluation services by a physician or other qualified healthcare professional.
  3. CPT 96132: This code is used for the first hour of neuropsychological testing evaluation services by a physician or other qualified healthcare professional.
  4. CPT 96133: This code is used for each additional hour of neuropsychological testing evaluation services by a physician or other qualified healthcare professional.
  5. CPT 96138: This code is used for the administration and scoring of a single psychological or neuropsychological test by a technician.

10. Examples

Here are 10 detailed examples of CPT code 96136 procedures:

  1. A physician administers and scores the Wechsler Intelligence Scale for Children (WISC) and the Minnesota Multiphasic Personality Inventory (MMPI) for a child with suspected learning disabilities and emotional issues.
  2. A neuropsychologist administers and scores the Trail Making Test and the Wisconsin Card Sorting Test for an adult patient with suspected executive functioning deficits.
  3. A clinical psychologist administers and scores the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI) for a patient with suspected mood and anxiety disorders.
  4. A psychiatrist administers and scores the Autism Diagnostic Observation Schedule (ADOS) and the Social Responsiveness Scale (SRS) for a child with suspected autism spectrum disorder.
  5. A geriatric psychologist administers and scores the Montreal Cognitive Assessment (MoCA) and the Geriatric Depression Scale (GDS) for an elderly patient with suspected cognitive decline and depression.
  6. A rehabilitation psychologist administers and scores the Functional Independence Measure (FIM) and the Disability Rating Scale (DRS) for a patient with a traumatic brain injury.
  7. A school psychologist administers and scores the Woodcock-Johnson Tests of Achievement and the Conners Comprehensive Behavior Rating Scales for a student with suspected attention-deficit/hyperactivity disorder (ADHD) and learning difficulties.
  8. A forensic psychologist administers and scores the Hare Psychopathy Checklist-Revised (PCL-R) and the Structured Clinical Interview for DSM-5 (SCID-5) for a criminal defendant undergoing a psychological evaluation.
  9. A health psychologist administers and scores the Pain Catastrophizing Scale (PCS) and the Pain Disability Index (PDI) for a patient with chronic pain.
  10. A neuropsychologist administers and scores the Boston Naming Test and the California Verbal Learning Test (CVLT) for a patient with suspected memory impairments.

Similar Posts

Leave a Reply

Your email address will not be published. Required fields are marked *