CPT Code 96133: Neuropsychological Testing Evaluation, Each Additional Hour

What is CPT code 96133?

When it comes to psychological and neuropsychological testing, there are different service categories you’ll need to document, like test evaluation services, test administration and scoring, and neurobehavioral status exams.

Each of these has specific CPT codes, and one of them is 96133. This code is closely related to 96132, which covers the first hour of neuropsychological testing evaluation services by a qualified healthcare professional. It includes tasks like integrating patient data, interpreting standardized test results, clinical decision-making, treatment planning, and providing feedback to the patient or their caregiver.

CPT code 96133 is considered an add-on code and is used for each additional hour beyond the first. You would use this code when your evaluation extends past the initial hour covered by 96132. It helps in coding the additional time and effort required for more in-depth assessments.

Using 96133 ensures that your documentation and billing accurately reflect the full scope of your clinical work.

96133 CPT code documentation requirements

To properly bill CPT code 96133, you need to document the extended time and clinical work performed beyond the initial hour covered by 96132.

The code supports the additional effort required when neuropsychological testing services go beyond what is captured in the base code. Your documentation should include:

• Time spent beyond the initial hour (including start and end times)
• Tests reviewed and interpreted during the extended evaluation
• Patient interaction, such as interviews, behavioral observations, or collateral input
• Data synthesis from multiple sources, including test results and clinical information
• Integration of findings into a written report, treatment plan, or feedback session

Thorough documentation helps justify the use of the add-on code and supports the medical necessity of your services.

96133 CPT code billing guidelines

CPT code 96133 is part of the neuropsychological testing codes and is meant to reflect extended clinical work such as interpretation, integration, and feedback. Here are some things to keep in mind when using this code:

• 96133 must always be billed alongside 96132, which covers the initial hour of service. It is not a stand-alone code and will be denied if submitted without the primary evaluation code.
• You must document the time spent beyond the first hour, along with the complexity of the evaluation process. Include start and end times, and explain why extended time was clinically necessary.
• Billable time must involve either direct interaction with the patient or active clinical work, such as interpreting test results and integrating findings into a report or treatment plan. Passive tasks like scoring or administrative duties are not covered under 96133.
• Align with the Medicare Benefit Policy Manual when coding psychological and neuropsychological evaluation services. Make sure your billing practices follow the Medicare and other payer-specific rules.
• Do not confuse with psychiatric diagnostic evaluation codes. 96133 is used for extended neuropsychological testing, not for general psychiatric diagnostic evaluations like 90791. These codes serve different purposes and should be applied based on the specific nature of the clinical work performed.

Following these guidelines helps protect your reimbursement, ensures compliance with payers, and reflects the depth of your clinical effort.

Other related codes

Other related codes that are useful in psychological and neuropsychological testing evaluation services include the following:

Psychological testing 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)

Neuropsychological test administration and scoring

• 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)