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TRICARE Policy Manual 6010.60-M, April 1, 2015
Medicine
Chapter 7
Section 3.10
Psychological Testing
Issue Date:  March 13, 1992
Copyright:  CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Revision:  C-46, April 30, 2019
1.0  CPT PROCEDURE CODES
96130, 96131, 96136 - 96139, 96146
2.0  DESCRIPTION
Psychological testing, with written report, per hour (assessment).
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.
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