Page 102 - Medicare Benefit Policy Manual

• They have the right to bill directly, collect and retain the fee for their services.

A psychologist practicing in an office located in an institution may be considered an
independently practicing psychologist when both of the following conditions exist:

• The office is confined to a separately-identified part of the facility which is used
solely as the psychologist’s office and cannot be construed as extending
throughout the entire institution; and

• The psychologist conducts a private practice, i.e., services are rendered to patients
from outside the institution as well as to institutional patients.

Payment for Diagnostic Psychological and Neuropsychological Tests

Expenses for diagnostic psychological and neuropsychological tests are not subject to the
outpatient mental health treatment limitation, that is, the payment limitation on treatment
services for mental, psychoneurotic and personality disorders as authorized under Section
1833(c) of the Act. The payment amount for the new psychological and
neuropsychological tests (CPT codes 96102, 96103, 96119 and 96120) that are billed for
tests performed by a technician or a computer reflect a site of service payment differential
for the facility and non-facility settings. CPs, NPs, CNSs and PAs are required by law to
accept assigned payment for psychological and neuropsychological tests. However,
while IPPs are not required by law to accept assigned payment for these tests, they must
report the name and address of the physician who ordered the test on the claim form
when billing for tests.

CPT Codes for Diagnostic Psychological and Neuropsychological Tests

The range of CPT codes used to report psychological and neuropsychological tests is
96101-96120. CPT codes 96101, 96102, 96103, 96105, 96110, and 96111 are
appropriate for use when billing for psychological tests. CPT codes 96116, 96118, 96119
and 96120 are appropriate for use when billing for neuropsychological tests.

All of the tests under this CPT code range 96101-96120 are indicated as active codes
under the physician fee schedule database and are covered if medically necessary.

Payment and Billing Guidelines for Psychological and Neuropsychological Tests

The technician and computer CPT codes for psychological and neuropsychological tests
include practice expense, malpractice expense and professional work relative value units.
Accordingly, CPT psychological test code 96101 should not be paid when billed for the
same tests or services performed under psychological test codes 96102 or 96103. CPT
neuropsychological test code 96118 should not be paid when billed for the same tests or
services performed under neuropsychological test codes 96119 or 96120. However, CPT
codes 96101 and 96118 can be paid separately on the rare occasion when billed on the