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 Independence 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 policies
For more information, including a complete list of medical necessity
criteria for neuropsychological testing and the updated billing requirements,
please refer to the following Independence policies, which were posted as
Notifications on December 27, 2017, and will go into effect March 27,
2018:
- Commercial: #07.03.08g: Neuropsychological Testing for
Neurologically Based Conditions
- Medicare Advantage: #MA07.038c: Neuropsychological Testing
for Neurologically Based Conditions
To view the Notifications for these policies, visit our Medical Policy Portal and select Accept and Go to
Medical Policy Online. Then select either Commercial or
Medicare Advantage under Active Notifications.
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