In this article, we’ll review how to use CPT Code 96116 for neurobehavioral status exam evaluations and how to bill CPT Code 96116.

Evolving over time, this code has become pivotal in supporting comprehensive neurological care, reflecting its growing significance in accurately diagnosing and treating patients with complex neurobehavioral issues. Let’s discuss it in detail.

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Article Index

• Description
• Time Frame
• Reimbursement Rate
• How to Bill

CPT Code 96116 Description

96116 Definition: Neurobehavioral status examination

Example Case:

Consider a client experiencing memory lapses and mood swings, we’ll call her Sarah.  Her neurologist uses 96116 to bill for a comprehensive neurobehavioral status exam. This code encompasses a range of assessments from cognitive testing to emotional evaluations, crucial for diagnosing conditions like Sarah’s, which was later identified as early-onset dementia.

CPT Code 96116 covers these in-depth evaluations, providing a framework for healthcare professionals to explore and document neurobehavioral changes.

The insights gained from Sarah’s assessment led to a tailored treatment plan, significantly improving her quality of life.

This example highlights the profound impact of neurobehavioral assessments, not just in diagnosis but also in shaping effective treatment strategies. (Source)

Neurobehavioral Examination: Testing and Scoring

There are many different mythologies for conducting neurobehavioral examinations.  Most of these mythologies involve scoring a client based on a set of cognitive examination categories: language, constructions, memory, calculations, and reasoning.  (Source).

In other language, the American Psychological Association describes these categories as “thinking, reasoning, and judgement,” with testing based on “acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities”.  (Source)

Scoring is conducted per category, whereupon a final score is added together for the complete neurobehavioral exam results.  (Source)

It’s worth noting that these are medical assessments specific to the mental health of the client based on their brain health, not talk therapy, and as such, most mental health professionals are not eligible to conduct these services.

Time Frame for CPT Code 96116: 30-90 Minutes

Neurobehavioral status exams can vary significantly in length, often ranging from 30 to 90 minutes. This variation largely depends on the patient’s specific condition and needs.

This flexibility in the time frame as accounted for in CPT Code 96116 ensures that each patient receives a tailored assessment. It is crucial for accurate diagnosis and treatment planning.

Consequently, the billing under this code reflects the depth and complexity of the examination, aligning with the individualized care provided.

Reimbursement Rate for CPT Code 96116: $90.37

Tracing the reimbursement rates for CPT Code 96116 reveals a notable trend.

• In 2022, the rate for a neurobehavioral status exam was set at $104.73.
• However, by 2023, this rate decreased to $93.19.
• In 2024, it further adjusted to $90.37.

This downward shift in reimbursement rates has significant implications. While the decrease might seem marginal, it reflects broader trends in healthcare funding and reimbursement.  We would recommend utilizing this examination alongside of other appropriate neuropsychological tests to ensure a thorough evaluation of the client is conducted. (Source)

How to Bill 96116

• Record the specifics of the neurobehavioral exam, including assessment types and duration.  Accuracy in documentation is key to successful billing.
• Ensure the exam is covered under the patient’s insurance plan via an eligibility and benefits verification call (see script).
• Apply code 96116 for the initial hour of the neurobehavioral status exam during claims submission.
• Use separate codes for any time beyond the first hour.
• Double-check all details to prevent errors that could lead to claim rejections.

A thorough review process is crucial for smooth claim processing, so consider hiring a billing service or make sure to stay on track when following the status of your claims. (Source)

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