CPT codes 101: An overview of current procedural terminology
One of the most critical components for billing with medical insurance is using Current Procedural Terminology (CPT) codes. These are standardized codes used by all healthcare professionals to describe medical, surgical, and psychological services. To bill a procedure or service accurately, you must provide the appropriate CPT code.
Regarding psychological testing and evaluation, CPT codes stand as a guide when selecting the most appropriate code for specific services.
For example, when performing a psychological assessment, you would use CPT codes 90791-90792, depending on the complexity of the assessment. The same applies to any treatment rendered.
You can read our guide to using CPT codes to refresh your coding skills or learn how the codes work. However, note that CPT codes may vary yearly due to medical procedures or technology changes.
Why are CPT codes used in mental health?
CPT codes are primarily used to ensure accuracy when billing medical insurance providers for mental health services. They provide a standardized language that all healthcare providers and insurers can understand, making the billing and reimbursement process smoother.
In addition, CPT codes help healthcare providers track and trend the types of services offered to improve the quality of care to their patients. This is done by using the data gathered from CPT codes to identify areas where more resources or changes may be needed to support better mental health outcomes among their patient population.
Suppose you are a clinician providing mental health services. In that case, it's incredibly vital that you use the correct and up-to-date CPT codes to ensure you are accurately compensated for your services. The American Psychological Association (APA) provides a comprehensive list of all the CPT codes relevant to your services.
For instance, CPT codes for therapy services range from 90834 (individual psychotherapy) to 90837 (group psychotherapy). CPT codes also apply to other mental health services, such as psychological testing and assessment (90791-90792) and psychotherapy for crisis intervention (99408-99409).
CPT codes for psychological screening
Psychological screening helps identify potential mental health concerns in an individual, and CPT codes are necessary when submitting claims for this type of service. The most commonly used CPT codes for psychological screening are:
CPT code 96127
Code 96127 is for brief emotional/behavioral assessments that take less than 30 minutes. To use this code, you must provide the patient with an assessment instrument that includes at least one of the following criteria:
- a structured interview,
- self-report questionnaires or,
- performance-based measures.
Note that a CPT code for screening differs from a CPT code for psychological testing. These codes also differ from CPT codes for family therapy, which include 90847, 90846, and 90849.
CPT codes for testing
CPT codes for psychological testing are typically used when a healthcare professional evaluates cognitive functioning, intellectual capacities, academic achievement, and mental health. CPT codes used for psychological testing include:
CPT code 96136
Providers use this code when administering two or more psychological or neuropsychological tests of not more than 30 minutes. The code requires explicitly that the practitioner uses at least two tests using any method. Each additional 30 minutes would be billed using the CPT code 96137 and 96136.
To qualify for billing using these CPT codes for psychological testing, the minimum time should be 16 minutes and include the test's total duration.
For example, you can use 96136 and 96137 CPT codes for counseling when billing for a 47-minute session where the counselor administered two exams for testing.
CPT code 96138
You can use CPT code 96138 when a technician administers two or more psychological or neuropsychological tests or scoring that take 30 minutes or less. Just like CPT code 96136, this requires that at least two tests are administered in any method. For each additional minute administered, you can use CPT code 96139.
To use these psychological testing CPT codes, the test or scoring should take at least 16 minutes and includes the total time of administering the test.
CPT code 96146
When a computer administers a single psychological or neuropsychological test, providers use CPT code 96146 for billing. The test should be administered using a single automated instrument through an electronic platform. The results should be automated as well.
CPT codes for test evaluation
Psychological test evaluations also require CPT codes for billing. Test evaluation includes interpreting the results of psychological tests and providing a written report about the findings. The main CPT code for psychological evaluation is:
CPT code 96130
This code evaluates the results of psychological tests and provides a written report about the findings. It requires at least 30 minutes of evaluation by a qualified professional and should take at most 60 minutes. Along with this code of psychological evaluation, you can use CPT code 96131 if additional time is needed.
For instance, 96130 and 9631 CPT codes for occupational therapy evaluation billing can be used when a qualified professional takes 1 hour and 35 minutes to interpret test results and treatment plans and give feedback to the patient.
CPT codes provide a critical way to bill for psychological testing and evaluation accurately. Understanding these various CTP Codes can help you ensure accurate billing practices.
Do note that there's a difference between CPT codes and HCPCS (Healthcare Common Procedure Coding System) codes. While CPT codes are used for billing medical and surgical procedures, HCPCS codes are used for billing all other services, including drugs and supplies unrelated to any procedure.
With the right combination of CPT codes, you can save time and resources in your practice. Plus, you’ll be able to provide better patient care while staying on top of your finances.