MEDICARE PSYCH BILLING

[Jdmontee]

Hi All,

We have a new provider coming on board who will be performing neuropsych testing (96118) for Medicare patients to determine mental status for living independently etc.  Question is does anyone know for sure whether there is a limit on the number of hours for neuropsych testing with Medicare.  I have called Medicare with no clear answers so wanted to know if anyone has had experience billing Medicare for this and what knowledge you have regarding any limitations.

Thanks so much!

Joanne

[PMRNC]

You will not find written documentation for this nor any administrative answer.. just bill the unit's you actually document. It is NOT advised to use more than one test per patient on same day as that could trigger an audit. Medicare will review the testing on a case-by-case basis so make sure documentation substantiates each visit completely!  It is said that Medicare uses a limit of 4 unit's as a basis of coverage (non substantiated), in other words, they might review each claim with 96118 with units over 4.  You can find The latest guidelines here: http://www.div40.org/Committee_Activities_Pages/Advisory_Committee/Practice/NCCI_CMS_Testing_Alert.pdf

Additionally Some Medicare carriers have adopted Local Coverage Determinations (LCDs) which include a very specific list of ICD-9 Diagnosis Codes to be used for Psychiatry and Psychological services which include CPT Codes 96118, 96119. check with your specific carrier has adopted such a policy before billing for these procedures.

[Jdmontee]

Thanks Linda, your input is greatly appreciated!