Point32Health would like to offer a reminder for our provider partners of the appropriate billing practice for psychological and neuropsychological testing – particularly in cases when a provider can administer and interpret standardized tests that can be used in both psychological and neuropsychological evaluations.
In these cases, in accordance with the guidance offered on page 12 of the American Psychological Association’s 2024 Psychological and Neuropsychological Testing Billing and Coding Guide, please choose only the code that represents the predominant service being provided. The psychological test evaluation codes (CPT codes 96130-96131) and neuropsychological test evaluation services (CPT codes 96132-96133) should not be billed together in the same episode of care.
Whether using the Psychological and Neuropsychological Assessment Supplemental Form (the standard form from Mass Collaborative), our Tufts Health RITogether Prior Authorization Request for Psychological and Neuropsychological Testing Form, or another accepted form, please only check off codes from either the psychological testing column or the neuropsychological testing column.
We’ve updated our Behavioral Health and Substance Use Disorder Payment Policy to more clearly delineate this billing guidance.
For clinical criteria and prior authorization requirements, refer to our Neuropsychological and Psychological Testing and Assessment Medical Necessity Guidelines (MNG) and our Psychological and Neuropsychological Testing and Assessment Tufts Health Plan One Care and Tufts Health Plan Medicare Preferred MNG, which you can find in the Medical necessity guidelines section of our provider website.