In September, the American Medical Association (AMA) announced the release of the 2019 Current Procedural Terminology (CPT) code set. Over 300 CPT code changes are slated to take effect on January 1, 2019. While a majority of these changes will not affect behavioral health providers, some may.
The biggest changes for behavioral health providers involve coding for psychological and neuropsychological testing. Here are key changes that may affect you:
- The current CPT codes for psychological testing (96101, 96102) and neuropsychological testing (96118, 96119) will be obsolete and replaced with the new codes on January 1, 2019.
- Testing services will use a new coding structure—one code for the first hour of testing and an add-on code for each additional hour.
- There are new codes for when more than one test is administered and scored in a battery.
- Changes to the payment structure for psychological and neuropsychological testing will go into effect with the new codes.
For both psychological and neuropsychological testing, the 2018 codes each map to up to four new 2019 codes. The new coding structure separates billing for the first hour from each additional hour as well as distinguishes between evaluation services and test administration/scoring:
- 96101 for psychological testing by a psychologist or physician is replaced by 96130 and +96131 for psychological testing evaluation services and 96136 and +96137 for test administration and scoring.
- 96102 for psychological testing by a technician is replaced by 96130 and +96131 for psychological testing evaluation services and 96138 and +96139 for test administration and scoring.
- 96118 for neuropsychological testing by a psychologist or physician is replaced by 96132 and +96133 for neuropsychological testing evaluation services and 96136 and +96137 for test administration and scoring.
- 96119 for neuropsychological testing by a technician is replaced by 96132 and +96133 for neuropsychological testing evaluation services and 96138 and +96139 for test administration and scoring.
For a complete list of the new testing codes, their descriptions, and crosswalks to help you determine which codes you should use after January 1, read Psychological and Neuropsychological Testing Codes for Psychologists by the APA Practice Organization.
With these testing code changes, there will be approximately a 6% increase in reimbursement rates in the CMS Physician Fee Schedule with the exception of neuropsychological batteries administered and evaluated by psychologists, for which there will be approximately a 3% reduction in reimbursement. This new payment structure unbundles services so that appropriate rates can be billed for the services of psychologists and technicians and helps to ensure that psychologists are appropriately reimbursed for their time spent on services other than face-to-face time with the client. The new structure also makes it simpler to code for testing over multiple days of service.
For more information on the new testing codes and payment structure, read Up-to-Code: Understanding the new testing codes by the APAPO and watch the APAPO's webinar on the 2019 testing code changes.
For TherapyNotes™ Users: If you're affected by these testing code changes, be sure to create new service codes in TherapyNotes™. Do not delete your old service codes, and make sure to pick the right codes for the appropriate dates of service. To learn how to add new service codes, visit our Help Center and read How To: Add, Edit, and Delete Service Codes.
