1.0 CPT
PROCEDURE CODES
96130, 96131, 96136 - 96139,
96146
3.0 POLICY
Psychological testing and assessment is a covered
benefit when medically or psychologically necessary and is provided
in conjunction with otherwise covered psychotherapy or as a required
part of the assessment and reassessment process for Applied Behavior
Analysis (ABA) under the Comprehensive Autism Care Demonstration.
Note: Psychological tests are considered diagnostic
services and are not counted against the number of weekly hours
for ABA under the Comprehensive Autism Care Demonstration.
4.0 EXCLUSIONS
4.1 Payment
is specifically excluded for the Reitan-Indiana battery when administered
to a patient under age five and for self-administered tests to patients
under age 13.
4.2 Psychological testing and assessment as part
of an assessment for academic placement. This exclusion encompasses
all psychological testing related to educational programs, issues
or deficiencies. Testing to determine whether a beneficiary has
a learning disability if the primary or sole basis for the testing
is to assess for a learning disability.
4.3 Psychological testing related
to child custody disputes or job placement.
4.4 Psychological
testing done for general screening (in the absence of specific symptoms
of a covered mental disorder) to determine if individuals being
tested are suffering from a mental disorder.
4.5 Teacher
and parental referrals for psychological testing.
4.6 Testing
related to diagnosed specific learning disorders or learning disabilities
is excluded (encompasses reading disorder (also called dyslexia),
mathematics disorder, disorder of written expression and learning
disorder not otherwise specified).
4.7 Testing for a patient in a Residential Treatment Center (RTC) or Partial Hospitalization Program (PHP) is
included in the per diem rate and can not be separately reimbursed.
Also, payment billed by an individual professional provider not
employed by or under contract with the RTC or PHP is included in the
per diem rate.