Modifiers required for Psychological Testing

[PsychBiller]

The following CPT codes were all administered on the same day: 96101, 96102 & 96103 (all psychological testing).

When I submit the claim do I need to attach a modifier (maybe 59)?

Does the modifier need to appear on EVERY claim line? or do I exclude it from the first line?

I have read so much conflicting information about this and CANNOT find any definitive answer.

Any input would be greatly appreciated.

[rdmoore2003]

when I first started in mental health I posted this same question.    You cannot bill these codes together for same dos especially to medicare.  you can bill as many units for each code but insurances look at it as if the psychologist can do some of the testing today then psychologist should do all the testing today.  (hence 96101 vs 96102 in same day)

[PsychBiller]

This is what is stated on the APA site:

CMS issues clarification on billing codes for testing services
Clarifications address issues of when more than one code can be billed and when psychologists can bill for professional time
By Communications and Government Relations staff
December 8, 2011—In response to advocacy efforts by government relations staff at the APA Practice Organization and the Epilepsy Foundation, The Centers for Medicare and Medicaid Services (CMS) issued clarification on Medicare billing and payment policy for the use of Current Procedural Terminology (CPT®) codes when billing for psychological or neuropsychological testing services. The testing codes were revised in 2006 to enable psychologists and physicians to bill for testing services administered by a technician or computer.
As explained further below, the clarification addressed issues of when more than one code can be billed and when psychologists can bill for professional time as well as for testing administered by a technician or computer, among other issues.  A complete list of the questions and answers addressed by CMS is available on the CMS website.
Billing for more than one code
The responses provided by CMS clarified that when more than one test is administered on the same date to the same patient, the appropriate testing codes for psychological or neuropsychological testing by a physician/psychologist, technician or computer can be billed together. In addition, the agency explained that more than one code can also be billed when a psychologist needs to consolidate separate written reports and interpretations from distinct tests administered by technician or computer to the same patient on the same date into a comprehensive report.
Previously, some Medicare Administrative Contractors allowed psychologists to bill for testing by a physician/psychologist and testing by a technician or computer during the same encounter, while others did not. This information from CMS will resolve inconsistencies among the various Medicare Administrative Contractors on how to bill for testing services.



This would lead me to believe that there has been a change in policy.  Other sites state that you need to use Modifier 59 (some say on each claim line, some say not on the first claim line).

I am confused...

[rdmoore2003]

I have read this article many times.  I have had meetings about this.   It comes down to if you can get insurances to pay that way, great.  I have tried to do this as early as last month.  It just doesnt work this way.   However, if you are able to manipulate this system, please, please let us know.   There is also an article on APA website that also says that we can bill for testing before interpretation is done....ex.  testing done on 1st of the month-charge it to insurance and then later you can charge for write up time.....this also is not true.

[PMRNC]

I've never seem them paid on same day either. My clients know to break them out on different days.