Reimbursement:

Current billing codes provide a clear definition of professional neuropsychological / neurocognitive testing procedures for a clinics "test evaluation activities" and the "test administration and scoring activities" performed by a technician or qualified health professional for both in clinic and telehealth services.

CNS VS Clients can download the complete Reimbursement Guide in their CNS Vital Signs account.

HOW do I Bill for Assessment Procedure Services?

The Central Nervous System Testing Codes are used to report the procedure services provided during testing of the neurocognitive pathophysiology and neural systems of the central nervous system. The testing of neurocognitive processes, visual motor responses and abstractive abilities is accomplished by the combination of several types of testing procedures.

The CNS Vital Signs testing procedure contains ten separate tests of brain function that are auto-scored into clinical domains. With over 400+ peer reviewed articles the CNS Vital Signs assessment platform is a well-established, commonly reimbursed method for evaluating patients who demonstrate neurocognitive or behavioral abnormalities. CNS Vital Signs is also used in combination with validated paper and pencil-based testing and billed using the same codes. In general, Payers expect that the administration of these testing services will generate material that will be formulated and integrated into a report or automated results.

Neurocognitive testing such as CNS Vital Signs helps clinicians better understand the nature of their patient's illness, in making recommendations regarding coping with and compensating for their neurocognitive difficulties and encourages treatment adherence. Ultimately, the data accumulated from administering CNS Vital Signs can be used as an outcome measure or for generating clinical insights that improve future care strategies.

CNS Vital Signs provides a broad-spectrum OBJECTIVE, PRECISE, STANDARDIZED, and CORE set of neurocognitive or brain function clinical endpoints which supports many neuro-psych clinical guidelines and provides clinicians with a tool to enable evidence-based medicine.

For additional information from our practice development experts email support@cnsvs.com

WHY do Payers Reimburse a CNS Vital Signs Procedure?

Most payers consider computerized neurocognitive assessment procedures medically necessary because the assessment procedure aids in the assessment of neurocognitive impairment due to medical or psychiatric conditions. Examples of medical conditions that can benefit the evaluation and management of patients include, but are not limited to:

• Assessment of neurocognitive abilities following traumatic brain injury, stroke, or neurosurgery or relating to a medical condition, such as multiple sclerosis, epilepsy, hydrocephalus or AIDS.
• Assessment of neurocognitive functions to assist in the development of rehabilitation and/or management strategies for persons with neurological disorders.
• Needed in the differential assessment of psychogenic and neurogenic syndromes.
• Monitoring of the progression of neurocognitive impairment e.g., Multiple Sclerosis, effects of aging, etc.
• Pre-surgical clearance. An evaluation is sometimes required e.g., Obesity Surgery.
• Pre-radiological clearance. A serial evaluation of neurocognitive decline is sometimes required e.g., Alzheimer's PET scan.
• Brief-Core neurocognitive testing and rating scales are needed to aid in the intake or initial assessment of neurobehavioral (96116) or psychiatric (90801) conditions.
• Serial assessment is needed to evaluate treatment effects, develop treatment recommendations after a patient has been tried on various medications and/or psychotherapy, has not progressed in treatment, and continues to be symptomatic. CNS Vital Signs generates longitudinal views that are beneficial in tracking outcomes.
• Neurocognitive assessment may also be used in occupational or environmental medicine conditions e.g., evaluating the impact of chronic solvent or heavy metal exposure. In these cases, Neurocognitive testing may be covered by the worker's compensation carrier.
• Worker's compensation carriers may also provide coverage for neurocognitive assessments for disability qualification, or legal/court-related purposes.

Reimbursement for CNS Vital Signs is generally well accepted by most payers.

Central Nervous System Assessments / Tests (e.g., Neuro-Cognitive, Mental Status, Speech Testing)

Test Administration Services

96136 - Psychological or Neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method, first 30 minutes

96137 - Each additional 30 minutes (List separately in addition to code for primary procedure)

96138 - Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes

96139 - Each additional 30 minutes (List separately in addition to code for primary procedure)

Test Evaluation Services

96130 - Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour

96131 - Each additional hour (List separately in addition to code for primary procedure)

96132 - Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour

96133 - Each additional hour (List separately in addition to code for primary procedure)

Additional Billing Codes

99483 – Category I: Evaluation and Management "Cognitive Assessment and Care Plan Services" Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian e.g., spouse, informant. etc. in the office or other outpatient, home or domiciliary or rest home, with all the following required elements:

1. Cognition-focused evaluation including a pertinent history and exam. Use of standardized instruments to stage dementia.
2. Medical decision making of moderate or high complexity. (defined by the E/M guidelines).
3. Functional assessment including decision-making capacity.
4. Medication reconciliation and review for high-risk medications, if applicable.
5. Evaluation for neuropsychiatric and behavioral symptoms, including depression, including use of standardized instrument(s).
6. Identification of caregiver(s), caregiver knowledge, caregiver needs, social supports, and willingness of caregiver to take on caregiving tasks.
7. Evaluation of safety, including motor vehicle operation, if applicable.
8. Address palliative care needs, if applicable and consistent with beneficiary preference.
9. Creation of a care plan, including initial plans to address any neuropsychiatric symptoms, neuro-cognitive symptoms, functional limitations, and referral to community resources as needed; care plan shared with the patient and /or caregiver with initial education and support.

96116 - Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgement, e.g., acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; first hour

96121 - Each additional hour (List separately in addition to code for primary procedure)

90791 - Psychiatric Evaluation - exam (no medical services) for the elicitation of a complete medical and psychiatric history, a mental status examination, integrated biopsychosocial assessment, and an evaluation of the patient's ability and capacity to respond to treatment on an initial plan of treatment. Non-Prescriber.

90792 - Psychiatric Evaluation - exam (no medical services) for the elicitation of a complete medical and psychiatric history, a mental status examination, integrated biopsychosocial assessment, and an evaluation of the patient's ability and capacity to respond to treatment on an initial plan of treatment. Prescriber.

Developmental Testing

96112 - Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory, and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour

96121 - Each additional hour (List separately in addition to code for primary procedure)

Additional Codes (Rating Instruments)

96125 - Testing & Interpretation - Standardized cognitive performance testing (e.g. Ross Information Processing Assessment) per hour of a qualified health care professional's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report.

96127 - Brief emotional / behavioral assessment (e.g., limited (e.g., Pediatric Symptom Checklist, Vanderbilt AD/HD, SCARED, PHQ-9, depression inventory, ADHD attention-deficit/hyperactivity disorder scale), with scoring and documentation, per instrument.

WHO can Bill these Codes?

With 10 Normed Neurocognitive tests and over 50 psychological, PRO, mental health and other rating scales there are many procedure codes that can be billed using the CNS Vital Signs testing platform technologies. For neurocognitive testing CMS guidance says quote "...regulations allow a clinical psychologist (CP) or a physician to perform the general supervision assigned to ... psychological and neuropsychological tests. In addition, nonphysician practitioners such as nurse practitioners (NPs), clinical nurse specialists (CNSs) and physician assistants (PAs) who personally perform …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 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, and 96111 may be performed by these therapists. However, when PTs, OTs and SLPs perform these tests, they must be performed under the general supervision of a physician or a CP." NOTE: Each carrier/payer may have different testing and billing guidelines.

Additional Reimbursement Information

With the growing public health concerns about conditions such as Memory Loss (mild cognitive impairment, dementia), AD/HD, Stroke/Brain Injury, Multiple Sclerosis and Mood Disorders; CNS Vital Signs represents a major advancement in patient care, which will enable clinicians and practices to more affordably manage their patient's neurocognitive status.

Clinicians know that good health has many dimensions, but none are more important than the health of a patient's brain. Neurocognitive status is increasingly being recognized as a major factor in determining a person's quality of life and neurocognitive testing helps clinicians evaluate the health of the higher functions of the brain. As part of CNS Vital Signs commitment to advancing patient access to neurocognitive testing, we work with Public Payers such as the Centers for Medicare and Medicaid Services (CMS), and Private Payers such as health insurers to help ensure appropriate reimbursement for services involving our products.

Disclaimer:The information provided in this document was obtained from third-party sources and is subject to change without notice as a result of changes in reimbursement laws, regulations, rules, and policies. All content on this document is informational only, general in nature, and does not cover all situations or all payers' rules and policies. This content is not intended to instruct medical providers on how to use or bill for healthcare procedures, including new technologies outside of Medicare national guidelines. A determination of medical necessity is a prerequisite that CNS Vital Signs assumes will have been made prior to assigning codes or requesting payments. Medical providers should consult with appropriate payers, including Medicare fiscal intermediaries and carriers, for specific information on proper coding, billing, and payment levels for healthcare procedures. This information represents no promise or guarantee by CNS Vital Signs concerning coverage, coding, billing, and payment levels. CNS Vital Signs specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on this information.