Feature

In November, the American Medical Association (AMA) CPT Editorial Panel approved the Practice Organization's request to replace the existing Current Procedural Terminology, or CPT, testing codes--96100, 96115, and 96117--with an expanded series of codes beginning in 2006.

The Practice Organization sought the new codes as part of its multiyear effort to obtain a "professional work value" for testing and assessment codes--compensation that reflects psychologists' time and effort in providing these services.

Right now Medicare carriers are not reimbursed for professional work value as part of their payment for testing and assessment services. And because Medicare is often the model for the payment policies of private health plans, Medicare's incorporation of professional work values into payment for testing and assessment services would have a far-reaching impact, according to the Practice Organization.

In 2003, the AMA's reimbursement committee determined that it was unable to assign professional work values to the current testing codes because they do not distinguish aspects of the service performed by a professional from those performed by a technician or computer. In response, the APA Practice Organization successfully sought the 2006 testing and assessment codes, which make such a distinction.

Now that the CPT Editorial Panel has authorized the new codes, the Practice Organization will advance to the next stage of seeking professional work values.

The new codes

The new testing and assessment codes will capture the same types of services as the current codes. Yet the codes that take effect in 2006 will clearly establish whether the test administration portion of the service is done by a psychologist, or instead by a technician or computer. Interpretation and report by a psychologist will remain a key component of all the new codes.

While the new descriptors and code numbers will not be finalized until the 2006 CPT manual is ready for publication, a general overview is provided below. Importantly, the current codes (96100, 96115, and 96117) remain in effect through 2005. Ultimately, Medicare decides whether to assign professional work values to the codes based on the recommendations of the reimbursement committee.

  • Psychological testing. Code 96100 will be deleted and replaced by three new codes. The first will capture psychological testing when entirely administered, interpreted and reported by a psychologist. The second will be used when a technician administers the test and the psychologist does the interpretation and report. The third code will be billed when a computer is used for test administration and the psychologist does the interpretation and report.

  • Neuropsychological testing. Code 96117 also will be deleted and replaced by three new codes. Similar to the psychological testing codes, the three new codes will also distinguish among the three different forms of test administration. Selection of a particular code will depend upon whether the psychologist, a technician or a computer administers the test. All three new codes will include interpretation and report by the psychologist.

  • Neurobehavioral Status Exam. Code 96115 will be deleted and replaced by one new code that will reflect the administration of the neurobehavioral status exam, along with interpretation and report, by a psychologist. Unlike the codes above, the psychologist is responsible for all facets--administration, interpretation and report--of the service when this code is selected.

Next steps

The Practice Organization is preparing to gather data from practicing psychologists to substantiate its request to incorporate a professional work value component into reimbursement for the new testing codes. It plans to present survey data to the AMA's reimbursement committee in the spring of 2005.

Under the new codes effective in 2006, psychologists will continue to bill for the entire testing and assessment service, including when a technician or computer has administered the test. Any professional work value presumably would capture the extent of the professional's direct involvement (i.e., whether the psychologist actually administers the test or just provides the interpretation and report).

Although it is not a guarantee, having a professional work value incorporated into payment for the new codes likely will increase Medicare reimbursement amounts for psychologists who bill for these services, say staff of the Practice Organization.