Your Top 10 Psychological Billing Questions Answered

Understanding psychological billing is crucial for healthcare providers and their billing support staff. Despite the importance of this topic, many professionals still have questions about the best practices for using CPT codes, billing units, and avoiding audits.

To address these common concerns, we have compiled the top 10 most frequently asked questions from the Psychological Billing Webinar held in January. This webinar, titled "Neuropsychological and Psychological Testing through Private Insurance: Using CPT Codes, Billing Units, Avoiding Audits, and More," provided valuable insights into the complexities of psychological billing.

In this article, we aim to provide clear and concise answers to these questions, helping you navigate the intricacies of psychological billing with confidence.

1. Telehealth Coverage for Neuropsychological Testing

Question: Are there any updates on telehealth coverage for neuropsychological testing under Medicare past the March 31, 2025 extension?

Psychologists have had many concerns about the changes to telehealth coverage under Medicare in 2025, but the good news is that psychological and neuropsychological testing will continue to be covered when provided via telehealth services on a provisional basis for all of 2025.

2. Billing for Group Practices

Question: Is it a red flag to have an LPA do test administration and scoring billed under their EIN (96136/96137) while the report is written and billed under a different EIN (96130/96131)?

In summary, it is generally advised to avoid splitting the billing of test administration and scoring from the report writing under different EINs, as this could be seen as a red flag and may require thorough documentation to justify the necessity of such an arrangement. Improper billing practices, such as splitting services between different EINs, could raise flags. For detailed guidance, consulting with a billing expert or legal advisor may be beneficial.

3. Out-of-Network Testing

Question: For out-of-network or non-PAR testing that will be self-submitted by a client, what details (procedure, diagnosis, units, minutes, cost) are needed?

There are a number of details needed for self-submitted out-of-network testing, including:

• Procedure codes: These are the CPT codes that describe the specific tests or services provided.
• Diagnosis codes: These are the ICD-10 codes that indicate the medical necessity for the testing.
• Units: The number of units of each procedure code used.
• Minutes: The total time spent on each procedure.
• Cost: The charges associated with each procedure.

A complete episode of testing should include the procedure codes, diagnosis codes, units, minutes, and cost. Proper documentation and understanding of the correct use of CPT codes are crucial to avoid billing issues.

Overall, when self-submitting out-of-network or non-PAR testing, clients should ensure they have all the necessary details, including procedure codes, diagnosis codes, units, minutes, and cost, to facilitate accurate and complete reimbursement.

4. Maximizing Testing Billing

Question: How do you maximize testing billing (codes or otherwise) to gain the most profit from a single testing case?

One of the key strategies to maximize testing billing is to ensure that you are using the appropriate CPT codes for the services rendered. This includes understanding which codes are allowed and how many units of each code can be billed. Additionally, if testing takes place over multiple days, the claim should be submitted at the conclusion of the services. This helps in avoiding audits and ensures that the billing is consistent with insurance company rules and regulations.

Understanding the nuances of coding and billing and following efficient practices are crucial for maximizing profit. Complying with billing and coding regulations is also important to avoid costly errors and maximize reimbursement. In short, it is recommended to:

• Use the appropriate CPT codes and understand the limitations on units and combinations.
• Submit claims only after all testing-related services are completed.
• Avoid splitting testing claims into multiple DOS.
• Stay updated with the latest billing and coding regulations.
• Train staff and regularly review billing practices to ensure compliance and accuracy.

5. Insurance Coverage for Extended Intake

Question: How do you get a 90+ minute intake covered by insurance outside of intake and interactive complexity codes?

To get a 90+ minute intake covered by insurance outside of intake and interactive complexity codes, there are several strategies and best practices to consider:

• Use psychotherapy codes such as 90837 for a 60-minute session.
• Utilize prolonged service codes like 99354 for the first hour beyond the typical service time and 99355 for each additional 30 minutes.
• Ensure that the documentation clearly supports the necessity and duration of the extended intake session.

6. Neuropsych vs. Psych Codes

Question: What are the basics of when to use neuropsych vs. psych codes, and if there can ever be a combination on a superbill?

Psychological testing evaluates mental health and cognitive abilities, including emotional well-being, personality traits, and interpersonal dynamics. Examples include intelligence tests and personality tests. Neuropsychological testing, on the other hand, focuses on the relationship between brain function and behavior, assessing cognitive functions like memory, attention, and problem-solving abilities.

The feedback codes vary between psychological and neuropsychological tests. Providers should use the appropriate codes based on the type of testing conducted and avoid combining them on the same superbill. Here’s a breakdown of what the codes are and when to use them:

• Psychological Testing Codes (96130/96131): Used for evaluating mental health, cognitive abilities, emotional well-being, personality traits, and interpersonal dynamics.
• Neuropsychological Testing Codes (96132/96133): Used for assessing cognitive functions related to brain behavior, such as memory, attention, language, and problem-solving abilities.

  Providers should choose the appropriate set of codes based on the predominant focus of the evaluation.

7. Intake and Feedback Codes for Parents

Question: What are the intake and feedback codes for parents when dealing with assessments for children?

When dealing with assessments for children, the intake and feedback codes for parents are essential for accurate billing and ensuring that services are covered by insurance. The codes to know include:

• Intake Codes: 90791 or 90792 for the initial diagnostic evaluation (these codes do not have a documented time requirement and are typically used for sessions lasting 45-60 minutes).
• Feedback Codes: 90887 for providing feedback to parents about the assessment results.

  It is always best to double check that you are using the appropriate CPT codes for sessions to ensure proper billing and reimbursement.

8. Codes Rejected by Insurance

Question: Why does Wellmed reject 96136 and 96137, stating that these codes are not usually billed together?

Wellmed's rejection of 96136 and 96137 being billed together is likely due to their policy that these codes should be used in a specific sequence, with 96137 as an add-on to 96136. CPT code 96136 is defined as "Psychological or neuropsychological test administration and scoring by physician, two or more tests, any method; first 30 minutes," while 96137 is an add-on code for each additional 30 minutes. These codes are designed to be used in sequence, with 96137 being billed only after 96136.

There are similar issues with other CPT codes, indicating that insurance companies often have specific policies that prevent certain codes from being billed together because of their intended use and ordering.

9. Cognitive Assessment as Neuropsychological Evaluation

Question: Does conducting a cognitive assessment as part of a comprehensive psychological evaluation qualify as a neuropsychological evaluation, particularly if it includes components that address neuropsychological domains such as attention, memory, executive functioning, and processing speed?

Conducting a cognitive assessment as part of a comprehensive psychological evaluation can qualify as a neuropsychological evaluation if it includes components that address neuropsychological domains such as attention, memory, executive functioning, and processing speed. These domains are essential for evaluating brain function and cognitive abilities, making the assessment comprehensive and aligned with neuropsychological evaluation standards.

According to the Kingsley Clinic, neuropsychological testing is a specialized diagnostic approach used to assess brain function and cognitive abilities. It involves standardized tests and tasks that measure various cognitive areas, including memory, attention, problem-solving, and emotional regulation. These evaluations are commonly used to assess conditions like dementia, ADHD, and learning disabilities.

10. The Difference Between Neuropsychological and Psychological Evaluations

Question: What is the difference between a Neuropsychological Evaluation and Psychological Evaluation?

While both neuropsychological evaluations and psychological evaluations use overlapping tests, there are a few key differences. A psychological evaluation includes a clinical interview as well as a variety of tests and is used to understand an individual's psychological functioning and guide treatment. It is typically performed by clinical psychologists and can address questions related to mental health, school and behavior-related issues, and psycho-legal questions.

A neuropsychological evaluation is broader in scope and more detailed than a psychological evaluation. These evaluations are commonly used to help clinicians diagnose neurological conditions.

In short, the difference lies in the focus of each type of evaluation:

• Psychological evaluation: Focuses on emotional, behavioral, and psychological functioning. It includes a variety of tests to clarify diagnoses and guide treatment for mental health issues.
• Neuropsychological evaluation: Focuses on cognitive functions related to brain behavior. It includes detailed and specialized tests to assess memory, attention, executive functioning, and other cognitive abilities, often used by clinicians to help them diagnose neurological conditions.

Have More Questions About Psychological Billing?

Understanding the appropriate use of CPT codes and evaluation types is crucial, but it can also be confusing. Available to watch on-demand on the PAR Training website, Dr. Fleck's webinar on psychological billing provides valuable insights into these complexities, helping to clarify when and how to use specific codes for various psychological and neuropsychological evaluations. In this webinar, Dr. Fleck addresses common questions about billing practices, such as the appropriate use of intake and feedback codes for parents, maximizing billing for profit, and distinguishing between psychological and neuropsychological evaluations.

Some of the key takeaways include:

• Billing codes and practices: Use appropriate CPT codes to avoid red flags and ensure proper reimbursement.
• Self-submission of out-of-network testing: Provide detailed information for accurate reimbursement.
• Maximizing billing for profit: Use CPT codes efficiently and stay updated with billing regulations.
• Extended intake sessions: Use psychotherapy and prolonged service codes for extended sessions.
• Neuropsych vs. psych codes: Distinguish between psychological and neuropsychological evaluations.
• Parent intake and feedback codes: Use specific codes for parent sessions when assessing children.
• Insurance rejections: Understand insurance policies to prevent billing issues.
• Qualifying neuropsychological evaluations: Include neuropsychological domains in comprehensive evaluations.
• Differences between evaluations: Understand the focus of psychological vs. neuropsychological evaluations.

For more detailed information or specific guidance, we recommend consulting with billing experts, attending relevant training sessions, or referring to authoritative resources on psychological billing practices. Staying informed and compliant with the latest billing regulations and guidelines will ensure accurate and efficient billing processes.