New CPT^® Codes for Psychological Testing

The information provided below is provided to alert you to the new codes. It is not provided as legal advice or as a substitute for the judgment of your coding specialist.

The APA Practice Organization successfully sought the revised codes to obtain a “professional work value” for testing and assessment codes. These codes reflect a greater recognition of the value of assessment services provided by psychologists². These codes will distinguish whether a psychologist, physician, technician, or computer administers the testing:

The new codes are published in the CPT^® 2006 Professional Edition manual and is available from the AMA at 1.800.621.8335. The APA website www.apapractice.org provides a series of announcements about the new CPT codes including latest news and information, Q & A, billing examples and estimated Medicare fee schedule.

For instance, the communication entitled “Questions and Answers About the 2006 Revised CPT Testing Codes” by the Federal Regulatory Affairs Staff (http://www.apapractice.org/apo/Q_A.html#) offers the following example for billing:

APA notes that it is important to properly document and bill insurers using the new codes. As noted above, the new codes specify who administers the testing (psychologist/physician, technician or computer) and for how long (hourly units for administration by professional or technician, and by a single code if the test was administered via computer)⁵. APA also notes that it is important to document what the Centers for Medicare and Medicard Services calls “medical necessity,” to confirm that the service being provided is necessary to improve or maintain a patient’s health⁶.

With these codes now in effect for Medicare reimbursement, other insurance companies may adopt Medicare reimbursement policies. It may be beneficial to consult with individual insurance carriers in advance to determine if they will require these codes for reimbursement. When new codes are introduced, additional communication and education may be required between providers and payers. When using the new codes, it also may be helpful to attach a cover page indicating information about the new codes to the insurance carrier.

References

1. Monitor on Psychology, V36, N10, Nov 2005
2. 2006 Revised CPT Testing Codes: The Latest News and Information from the APA Practice Directorate by Federal Regulatory Affairs and Legal and Regulatory Affairs Staff
3. Current Procedural Terminology © 2005 American Medical Association. All Rights Reserved.
4. Questions and Answers About the 2006 Revised CPT Testing Codes. (2006). Retrieved January 23, 2006, from http://www.apapractice.org/apo/Q_A.html
5. Monitor on Psychology, V36, N10, Nov 2005
6. Monitor on Psychology, V36, N10, Nov 2005

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