How To Use CPT Code 96020

CPT 96020 describes the selection and administration of neurofunctional testing during noninvasive imaging functional brain mapping, performed by a physician or other qualified healthcare professional. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 96020?

CPT 96020 can be used to describe the selection and administration of neurofunctional testing during noninvasive imaging functional brain mapping. This code is used when a physician or other qualified healthcare professional performs a series of tests to evaluate and map the primary brain activities related to motor, sensory, and language functions. The tests are conducted using functional magnetic resonance imaging (fMRI) to record the mapping of blood flow in the brain in response to the administered tests. The purpose of this procedure is to accurately localize critical brain areas controlling motor, sensory, and language functions.

2. Official Description

The official description of CPT code 96020 is: ‘Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered entirely by a physician or other qualified healthcare professional (i.e., psychologist), with review of test results and report.’

3. Procedure

1. The provider performs a series of tests to evaluate and map the primary brain activities related to motor, sensory, and language functions.
2. The tests are conducted using functional magnetic resonance imaging (fMRI) to record the mapping of blood flow in the brain in response to the administered tests.
3. The patient is given specific tasks related to particular brain functions, such as completing sentences for language mapping or performing bilateral hand squeeze tasks for sensory and motor mapping.
4. The provider reviews the test results and prepares a report based on the findings.

4. Qualifying circumstances

CPT 96020 is performed by a physician or other qualified healthcare professional. It is used for neurofunctional testing selection and administration during noninvasive imaging functional brain mapping. The test must be administered entirely by the provider, and they must review the test results and prepare a report. This code should not be reported in conjunction with codes 96112, 96113, 96116, 96121, 96130, 96131, 96132, or 96133. Additionally, it should not be reported in conjunction with code 70554.

5. When to use CPT code 96020

CPT code 96020 should be used when a physician or other qualified healthcare professional performs neurofunctional testing during noninvasive imaging functional brain mapping. It is appropriate to report this code when the provider administers the tests entirely and reviews the test results to prepare a report. This code should not be reported on the same day as evaluation and management services codes.

6. Documentation requirements

To support a claim for CPT code 96020, the provider must document the following information:

• Patient’s diagnosis and the need for neurofunctional testing
• Specific tests administered during the procedure
• Date of the procedure
• Review of test results
• Preparation of a report based on the findings

7. Billing guidelines

When billing for CPT code 96020, ensure that the procedure is performed by a physician or other qualified healthcare professional. If reporting only the professional component, append modifier 26 to the code. If reporting only the technical component, append modifier TC to the code, unless the hospital provided the technical component. Do not append a professional or technical modifier when reporting a global service in which one provider renders both components. Do not report CPT code 96020 in conjunction with codes 96112, 96113, 96116, 96121, 96130, 96131, 96132, or 96133. Additionally, do not report it in conjunction with code 70554. Evaluation and management services codes should not be reported on the same day as CPT code 96020.

8. Historical information

CPT code 96020 was added to the Current Procedural Terminology system on January 1, 2007. The code was later changed on January 1, 2013, with an updated description.

9. Examples

1. A physician performing neurofunctional testing during noninvasive imaging functional brain mapping to evaluate motor functions in a patient with a suspected brain injury.
2. A qualified healthcare professional administering tests to map language functions using fMRI in a patient with a language disorder.
3. A physician conducting neurofunctional testing to evaluate sensory functions in a patient with a suspected nerve damage.
4. A qualified healthcare professional performing tests to map motor functions in a patient with a movement disorder.
5. A physician administering tests to evaluate language functions in a patient with a suspected cognitive impairment.
6. A qualified healthcare professional conducting neurofunctional testing to map sensory functions in a patient with a sensory processing disorder.
7. A physician performing tests to evaluate motor functions in a patient with a suspected brain tumor.
8. A qualified healthcare professional administering tests to map language functions in a patient with a history of stroke.
9. A physician conducting neurofunctional testing to evaluate sensory functions in a patient with chronic pain.
10. A qualified healthcare professional performing tests to map motor functions in a patient with a spinal cord injury.