Page 100 - Medicare Benefit Policy Manual

(Rev. 85, Issued: 02-29-08, Effective: 01-01-06, Implementation: 12-28-06)

Medicare Part B coverage of psychological tests and neuropsychological tests is
authorized under section 1861(s)(3) of the Social Security Act. Payment for
psychological and neuropsychological tests is authorized under section 1842(b)(2)(A) of
the Social Security Act. The payment amounts for the new psychological and
neuropsychological tests (CPT codes 96102, 96103, 96119 and 96120) that are effective
January 1, 2006, and are billed for tests administered by a technician or a computer
reflect a site of service payment differential for the facility and non-facility settings.
Additionally, there is no authorization for payment for diagnostic tests when performed
on an “incident to” basis.

Under the diagnostic tests provision, all diagnostic tests are assigned a certain level of
supervision. Generally, regulations governing the diagnostic tests provision require that
only physicians can provide the assigned level of supervision for diagnostic tests.
However, there is a regulatory exception to the supervision requirement for diagnostic
psychological and neuropsychological tests in terms of who can provide the supervision.
That is, regulations allow a clinical psychologist (CP) or a physician to perform the
general supervision assigned to diagnostic psychological and neuropsychological tests.

In addition, nonphysician practitioners such as nurse practitioners (NPs), clinical nurse
specialists (CNSs) and physician assistants (PAs) who personally perform diagnostic
psychological and neuropsychological tests are excluded from having to perform these
tests under the general supervision of a physician or a CP. Rather, NPs and CNSs must
perform such tests under the requirements of their respective benefit instead of the
requirements for diagnostic psychological and neuropsychological tests. Accordingly,
NPs and CNSs must perform tests in collaboration (as defined under Medicare law at
section 1861(aa)(6) of the Act) with a physician. PAs perform tests under the general
supervision of a physician as required for services furnished under the PA benefit.

Furthermore, physical therapists (PTs), occupational therapists (OTs) and speech
language pathologists (SLPs) are authorized to bill three test codes as “sometimes
therapy” codes. Specifically, CPT codes 96105, 96110 and 96111 may be performed by
these therapists. However, when PTs, OTs and SLPs perform these three tests, they must
be performed under the general supervision of a physician or a CP.

Who May Bill for Diagnostic Psychological and Neuropsychological Tests
• CPs - see qualifications under chapter 15, section 160 of the Benefit Policy Manual,
Pub. 100-02.

• NPs -to the extent authorized under State scope of practice. See qualifications
under chapter 15, section 200 of the Benefit Policy Manual, Pub. 100-02.

• CNSs -to the extent authorized under State scope of practice. See qualifications
under chapter 15, section 210 of the Benefit Policy Manual, Pub. 100-02.