Psychological Testing and Evaluation Code Changes

PROVIDER ALERT

 The Centers for Medicare and Medicaid Services (CMS) has revised the procedure codes for billing psychological testing and evaluation. The South Carolina Department of Health and Human Services (SCDHHS) transitioned to the use of these codes effective July 1, 2019. The following codes were impacted: 

Current Procedural Terminology (CPT) code 96101 (psychological testing with interpretation and report by psychologist or physician; per hour) was replaced by the following: 

• 96130 (psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member[s] or caregiver[s], when performed; first hour) 

• 96131 (psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member[s] or caregiver[s], when performed; each additional hour [list separately in addition to code for primary procedure]) 

• 96136 (psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes) 

• 96137 (psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; each additional 30 minutes [list separately in addition to code for primary procedure]) 

CPT code 96102 (psychological testing with interpretation and report by technician; per hour) was replaced by the following: 

• 96138 (psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes) 

• 96139 (psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; each additional 30 minutes [list separately in addition to code for primary procedure]) 

Please refer any questions or concerns regarding this alert to the Healthy Connections Provider Service Center at (888) 289-0709. 

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

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