Author Topic: PsyD Medicare provider billing 96101 - getting denial  (Read 3835 times)

barb2512

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PsyD Medicare provider billing 96101 - getting denial
« on: March 23, 2019, 03:55:53 PM »
I am looking for guidance billing for a PsyD in Florida. She is doing 96101 and we are getting rejections. Medicare doesn't hang onto the claim long enough to process and deny, so I can not get an answer from First Coast as to why this cpt code is being rejected. I looked up on the cms website and found this - below- but I do not find a link to the actual Q&A's. I can not find my answer on their website. I do not have a reason why it is rejected- any guidance is appreciated.

Psychological and Neuropsychological Tests
CMS released questions and answers on psychological and neuropsychological tests that are billed under the CPT code range 96101-96125.  These Frequently Asked Questions (FAQs) provide clarification on Medicare billing and payment policy for these testing codes when performed by technicians, computers, physicians, clinical psychologists, independently practicing psychologists and other eligible qualified nonphysician practitioners.  The scenarios under the FAQs also address situations where more than one of these testing codes can be billed for services furnished to the same patient.

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Kerry

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Re: PsyD Medicare provider billing 96101 - getting denial
« Reply #1 on: March 23, 2019, 10:03:16 PM »
96101-96103, 96118-96120 are no longer valid testing codes for 2019.  You need to refer to 2019 CPT codes for testing.  You also need to indicate on the claim the Referring provider name even if same provider who is doing the testing.  Hope that makes sense.

PMRNC

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Re: PsyD Medicare provider billing 96101 - getting denial
« Reply #2 on: March 25, 2019, 04:40:28 PM »
Kerry is correct..the new codes are as follows:

96101 for psychological testing by a psychologist or physician is replaced by 96130 and +96131 for psychological testing evaluation services and 96136 and +96137 for test administration and scoring.

96102 for psychological testing by a technician is replaced by 96130 and +96131 for psychological testing evaluation services and 96138 and +96139 for test administration and scoring.

96118 for neuropsychological testing by a psychologist or physician is replaced by 96132 and +96133 for neuropsychological testing evaluation services and 96136 and +96137 for test administration and scoring.

96119 for neuropsychological testing by a technician is replaced by 96132 and +96133 for neuropsychological testing evaluation services and 96138 and +96139 for test administration and scoring.
Linda Walker
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barb2512

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Re: PsyD Medicare provider billing 96101 - getting denial
« Reply #3 on: March 25, 2019, 06:07:47 PM »
Thank you all so much!!
Barbara
 :-* :-* :-*

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