96127
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
$5.01
Non-Facility
$5.01
Documentation Required
- The medical record must document the clinical reason(s) the tests are being performed and how results will impact diagnosis or treatment.
- Practitioners providing testing must have a Medicare provider number and be appropriately licensed in the state where services are provided; documentation of licensure and Medicare enrollment must be available.
- If testing involves a technician, the clinician's direct supervision must be documented; computerized administration must be documented when used.
- If testing is performed over multiple days, total testing time must be combined and reported on the last day of service.
Key Coverage Criteria
- Psychological or neuropsychological testing is medically necessary when results are used to make specific diagnoses or prognoses that directly inform treatment planning, treatment goals, treatment efficacy, or patient disposition.
- Testing of cognitive processes, visual-motor responses, and abstractive abilities to evaluate cognitive function of the central nervous system is covered when it affects the patient's plan of care.
- Assessment of aphasia is a covered indication (report with CPT code 96105 as applicable).
- Cognitive performance testing is a covered indication (report with CPT code 96125 as applicable).
- Developmental and behavioral screening and testing are covered indications (use CPT codes 96110, 96112, 96113, 96127 as applicable).
- Neurobehavioral status examinations (including test administration, scoring, interpretation and report) are covered (use CPT codes 96116 and 96121).
5 Active Policies
A57481 — Billing and Coding: Psychological and Neuropsychological Testing
J05
L34646 — Psychological and Neuropsychological Testing
J05
A59036 — Billing and Coding: Cognitive Assessment and Care Plan Service
L39266 — Cognitive Assessment and Care Plan Service
CIGNA-A004 — Preventive Care Services - (A004)
Related Codes
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