2025 CPT code 96136
(Active) Effective Date: N/A Medicine - Central Nervous System Assessments/Tests Feed
Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes.
Modifier 59 may be used to indicate a distinct procedural service when 96136 is billed with an E/M code for a separate and identifiable E/M service. Other modifiers like those for telehealth (GT, 95, G0) could apply if the service was performed using telemedicine.
Medical necessity for psychological/neuropsychological testing must be clearly documented. The testing should be related to the patient's diagnosis or suspected condition and be necessary for developing or modifying the treatment plan.For example, testing might be necessary to assess cognitive function after a head injury, evaluate personality factors contributing to depression, or aid in differential diagnosis of psychological disorders.
The physician or other qualified healthcare professional is responsible for explaining the tests, answering patient questions, administering the tests using any method (manual or automated), and scoring the tests according to standardized procedures.
In simple words: The healthcare provider gives you two or more psychological or brain function tests and scores them.This code covers the first 30 minutes of giving and scoring the tests.
This code represents the administration and scoring of two or more psychological or neuropsychological tests by a physician or other qualified healthcare professional, using any method, for the first 30 minutes.It includes the time spent explaining the tests to the patient, answering questions, administering the tests, and scoring them. The tests can be standardized psychological tests (personality, attitude, IQ, achievement) or neuropsychological tests designed to measure psychological functions linked to specific brain structures or pathways.
Example 1: A psychiatrist administers the Wechsler Adult Intelligence Scale (WAIS) and the Minnesota Multiphasic Personality Inventory (MMPI) to a patient to assess cognitive abilities and personality traits, taking 45 minutes to administer and score the tests. The psychiatrist would bill 96136 and one unit of 96137., A neuropsychologist administers a battery of tests to a patient suspected of having a traumatic brain injury. The tests take 25 minutes to administer and score. The neuropsychologist would bill 96136., A clinical psychologist assesses a patient for ADHD. The tests take 75 minutes to administer and score. The psychologist would bill 96136 along with two units of add-on code 96137.
Documentation should include the type and number of tests administered, the time spent on administration and scoring, the patient's performance on the tests, and any relevant observations.The medical record should also reflect the medical necessity for the testing, linking it to the patient's diagnosis and treatment plan. Supporting documentation might include prior medical records, referral information, and patient history.
** Always check with specific payer guidelines for coverage and documentation requirements as they can vary. As of 2024-12-01, telehealth, including audio-only, is approved by CMS for 96136, but coverage and reimbursement details can vary. Check with private payers, Medicare Administrative Contractors (MACs), and other relevant parties for the latest information about telehealth and other payer-specific policies.
- Payment Status: Active
- Modifier TC rule: Not applicable. Modifier TC is used for the technical component of a service and does not apply to 96136.
- Fee Schedule: Fee schedules for CPT code 96136 vary depending on location, payer, and other factors. Refer to historical CMS fee schedules and private payer fee schedules for specific information.
- Specialties:Psychiatry, Psychology, Neurology, Clinical Neuropsychology,Pediatrics, Family Medicine, and potentially other specialties if the testing is medically necessary and within the scope of the provider's practice.
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital, and other settings where such testing is performed (e.g., telemedicine as applicable).