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Upcoming changes to billing requirements for neuropsychological testing for neurologically based conditions

December 27, 2017

Effective March 27, 2018, claims submitted for neuropsychological testing with CPT® codes 96118, 96119, and 96120 must include a primary ICD-10 diagnosis code that represents such a neurologically based condition, as current policy indicates that Independence will only cover neuropsychological testing for an individual if an associated neurologically based condition is suspected or diagnosed. Claims for conditions such as major depressive disorder or attention-deficit/hyperactivity disorder submitted without a neurologically based diagnosis code will not be covered.

Neurologically based conditions commonly produce changes in behavior, including impairment of cognitive abilities and production of neuropsychiatric symptoms. Neuropsychological testing is one means of garnering quantitative information about behavioral changes in individuals with known neurologic diseases or who are considered to be at risk for brain dysfunction.

Updated policies

For more information, including a complete list of medical necessity criteria for neuropsychological testing and the updated billing requirements, please refer to the following Independence policies, which were posted as Notifications on December 27, 2017, and will go into effect March 27, 2018:

  • Commercial: #07.03.08g: Neuropsychological Testing for Neurologically Based Conditions
  • Medicare Advantage: #MA07.038c: Neuropsychological Testing for Neurologically Based Conditions

To view the Notifications for these policies, visit our Medical Policy Portal and select Accept and Go to Medical Policy Online. Then select either Commercial or Medicare Advantage under Active Notifications.

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