What is it, who can bill for it and who will reimburse it?

What exactly is CPT Code 96103?

CPT Code 96103 has been used since 2006, so it isn’t brand new. However, the Affordable Care Act included mental healthcare in insurance plans across the country back in 2016. So, CPT COde 96103 began seeing quite a bit more usage. CPT Code 96103 is a code that may be used to report reimbursements for psychological testing. This includes the extremely popular PHQ-9 scale. This testing must be administered through the use of a computer. Then the analysis of the testing and the final report must be supplied by a certified healthcare professional.

The good news is that the certified professional overseeing and interpreting the testing does not need to be a mental health provider. Some examples of these professionals may include: physicians, nurse practitioners, clinical nurse specialists, physician assistants, physical therapists, speech pathologists and a variety of other healthcare providers.

Who can bill with CPT Code 96103?

A large majority of healthcare professionals can bill with CPT Code 96103. It is not only for therapists and mental healthcare providers. Psychological testing can be utilized in a variety of medical settings. This includes in pain management care when a patient is in severe, chronic pain, in health clinics looking for the initial signs of mental health disorders and in senior care, when discerning the patient’s ability to make decisions related to their health.

What procedures are there for billing CPT Code 96103?

This is relatively simple, without a long list of requirements. Often, patients who are experiencing ongoing medical problems can be the most at-risk for developing mental health disorders. Therefore, the main requirement for psychological testing is that it can be deemed medically necessary, with the suspicion of a mental health condition. Once this has been ascertained, the testing must be conducted by a computer. Then the results must be measured by a healthcare professional, who will also provide a detailed report.

The computerized testing code 96103 is not a time-based code. It can be used once per session, regardless of the number of test instruments utilized.

How often can testing be billed with CPT Code 96103?

Imagine how nice it would be to not only save administrative time by using standardized testing, but to be able to regularly bill them for the patients that they can benefit! CPT Code 96103 may be billed one time for each patient during a session, making use of any number of testing assessments. So, not only will clinicians have more efficient practices by utilizing these screenings, but they can also use them to build revenue.

How much are reimbursements for screenings billed using CPT Code 96103?

Billing with CPT Code 96103 is a flat fee up to $28 for each patient. This is billed as one service to the patient, regardless of how many tests are actually conducted during that session. This fee is also inclusive of analyzing and reporting the testing by a healthcare professional.

Who reimburses billing using CPT Code 96103?

CPT Code 96103 is reimbursed by many major insurance companies. These can include:  Cigna, Humana, Aetna, Anthem and Medicare.

Where can I find standardized screening instruments to use with CPT Code 96103?

Mentegram has a library full of online tools that range from detailed surveys to simple sliding scales that can be used to bill with CPT Code 96103, including the PHQ-9. Mental healthcare providers may also use these tools to help reduce and even replace paperwork. This can save valuable time in administration by screening the patients and monitoring their progression, even in between appointments.

Ask us how you can start billing with CPT Code 96103 and other codes today!

For more information on other ways to bill and increase your practice’s revenue, check out our articles on CPT Code 96127:

CPT Code 96127 – Answers to the frequently asked questions about billing this code

3 Online Screenings That Can Be Billed with CPT Code 96127

CPT Code 96127 – How to Increase Revenue with This New Behavioral or Emotional Assessment

DISCLAIMER: Please keep in mind that Mentegram is a software company, and do not consider content on our website as legal advice. It is your responsibility to decide to act on this content, relinquishing Mentegram of all claims. The information that we share is what has worked well for our customers. It is also curated content of the best practices from authorities. We don’t consider ourselves billing consultants and experts. If you aren’t sure, please consult the particular insurance company or billing consultant for additional information.

SOURCES:

http://www.cognitrax.com/Manuals/CognitraxReimbursementGuide.pdf

http://www.healthpsych.com/tools/pearson_billing_2008.pdf

http://www.medicalbillingcptmodifiers.com/2012/08/96101-96120-sychological-and.html

https://downloads.cms.gov/medicare-coverage-database/lcd_attachments/31990_1/l31990psych017cbg040112.pdf

https://www.supercoder.com/my-ask-an-expert/topic/for-96103-who-is-considered-qualified-professional

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