Medicare Compliance & Reimbursement - 2016 Issue 13
Part B Coding Coach: Identify the Provider to Assign the Right Code for Psychological Tests
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Article Overview
This article is a practical coding guide for psychological testing services under CPT, aimed at coders, billers, and clinicians who need to assign the correct code based on the provider type, administration setting, and timing of the service. It covers broad issues such as clinician-versus-technician administration, time calculation for per-hour reporting, documentation expectations, supervision and collaboration considerations, and when coding edits may affect billing for tests performed by different providers.
Why This Topic Matters
Accurate reporting for psychological testing depends on identifying the correct performer and counting time correctly, especially when services involve both clinicians and technicians. Misapplication can lead to claim denial, missed payment, or improper reporting when multiple providers or same-day services are involved.
Article Sections
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Report from These Two Choices for Psychological Tests
Introduces the two CPT testing options discussed in the article and frames the provider-based distinction used to select between them.
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Calculate Exact Time for Reporting Accurate Units of 96101 and 96102
Explains the time-based nature of the services, including how reporting is tied to service time and documentation of the work performed.
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Check if Other Qualified Persons Can Administer the Test(s)
Discusses additional provider types that may perform testing and references supervision and collaboration considerations relevant to these services.
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Don’t Report 96101 for Interpretation of Technician Administered Tests
Addresses the separation between technician-administered testing and professional interpretation/reporting in the context of reporting.
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Watch CCI When Reporting Different Provider Tests
Covers situations involving tests performed by different providers and the impact of coding edit interactions on same-day reporting.
What You Will Learn
- How psychological testing is categorized for coding purposes based on who administers and interprets the service.
- How time affects reporting for per-hour psychological testing services.
- How multi-provider scenarios and same-day testing situations can affect claim reporting.
- What broad documentation elements are relevant to support psychological testing claims.
- How coding edits may influence reporting when different tests are performed by different providers.
Who Should Read This
- Medical coders
- Billing specialists
- Physician practices
- Psychologists
- Psychiatrists
- Nurse practitioners
- Clinical nurse specialists
- Physician assistants
Codes Discussed
Modifiers Discussed
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