2025 CPT code 96125
(Active) Effective Date: N/A Revision Date: N/A Neuropsychological Testing - Central Nervous System Assessments/Tests Medicine Feed
Assessment of aphasia and cognitive performance testing, per hour, including interpretation and report.
Modifiers may apply depending on the circumstances of service. Refer to CPT guidelines for specific modifier application rules.
Medical necessity is established by a physician's documented clinical evaluation and findings indicating the need for cognitive and aphasia assessment to establish a diagnosis, guide treatment, or monitor treatment efficacy. The documentation must support that the level of service provided is medically necessary.
The clinical responsibility for 96125 lies with a physician or other qualified healthcare professional who administers the cognitive performance and aphasia tests, interprets the results, and prepares a report summarizing the findings. They must spend at least 16 minutes of face-to-face time for a 30-minute code and at least 31 minutes for a 1-hour code for accurate reporting.
In simple words: This code covers a doctor or other qualified professional's time spent giving tests to check a patient's thinking skills and ability to understand language (like after a stroke). The time includes face-to-face testing time, reviewing the results, and writing a report for the patient's medical record.This is billed per hour of the provider’s time.
This CPT code, 96125, reports the services provided during assessment of aphasia and cognitive performance testing.It includes the qualified healthcare professional's face-to-face time with the patient, administering tests, interpreting results, and preparing a report. The time reported encompasses the entire evaluation episode.Standardized instruments are used, and the assessment may involve evaluating memory, language, visual-motor responses, and abstract reasoning.The code does not include time for interactive feedback, which is separately reported.
Example 1: A patient presents post-stroke with suspected aphasia and cognitive impairment.The physician performs a comprehensive assessment using standardized tests, which takes approximately 1.5 hours.Code 96125 is reported for the evaluation time., A patient with a traumatic brain injury (TBI) undergoes cognitive testing to assess the extent of damage and inform rehabilitation planning. The neuropsychologist spends 2 hours with the patient for the evaluation. Two units of 96125 are reported., A patient exhibits symptoms suggestive of dementia.A neurologist administers a battery of cognitive tests, including tests of memory, language, and executive function.Code 96125 is reported for the time spent conducting the assessment and writing the report.
Detailed documentation is required, including the specific tests administered, the patient's responses, the interpretation of the results, and the supporting clinical data. The documentation should justify medical necessity. The total face-to-face time should be documented.
** Always ensure compliance with payer-specific guidelines and coding requirements before submitting claims.
- Revenue Code: T2D (Other Tests - Other)
- RVU: This information varies based on payer and location. Consult your specific payer's fee schedule.
- Payment Status: Active
- Modifier TC rule: The Technical Component (TC) modifier is not applicable.
- Fee Schedule: Historical fee schedules vary based on payer and location. Consult past fee schedules for specific historical information.
- Specialties:Neurology, Neuropsychology, Psychiatry, Speech-Language Pathology
- Place of Service:Office, Hospital (Inpatient or Outpatient), Ambulatory Surgical Center, other settings where neuropsychological testing is performed.