Effective March 27, 2018, claims submitted for neuropsychological testing with CPT^® codes 96118, 96119, and 96120 must include a primary ICD-10 diagnosis code that represents such a neurologically based condition, as current policy indicates that AmeriHealth will only cover neuropsychological testing for an individual if an associated neurologically based condition is suspected or diagnosed. Claims for conditions such as major depressive disorder or attention-deficit/hyperactivity disorder submitted without a neurologically based diagnosis code will not be covered.

Neurologically based conditions commonly produce changes in behavior, including impairment of cognitive abilities and production of neuropsychiatric symptoms. Neuropsychological testing is one means of garnering quantitative information about behavioral changes in individuals with known neurologic diseases or who are considered to be at risk for brain dysfunction.

Updated policy

For more information, including a complete list of medical necessity criteria for neuropsychological testing and the updated billing requirements, please refer to Claim Payment Policy #07.03.08g: Neuropsychological Testing for Neurologically Based Conditions, which was posted as a Notification on December 27, 2017, and will go into effect March 27, 2018.

To view the Notification for this policy, visit our Medical Policy Portal and select Accept and Go to Medical Policy Online. Then select Commercial under Active Notifications.

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