Psychological Testing Reimbursement Rates in 2021

Whether you’re a physician, psychologist, or technician, you need to understand the reimbursement rates for psychological or neuropsych testing in 2021.

psychological testing reimbursement ratesOur guide to psych testing reimbursement rates in 2021 will teach you what Medicare pays qualified therapists, psychiatrists, and health care professionals for these CPT codes.

Psych Testing Reimbursement Rates 2021

Please see our table below for reimbursement rate data per CPT code in 2021 and 2020.

CPT CodeDescriptionMedicare Reimbursement Rate 2020Medicare Reimbursement Rate 2021
90791Psychological Diagnostic Evaluation$140.19$180.75
90792Psychological Diagnostic Evaluation with Medication Management$157.49$201.68
90832Individual Psychotherapy, 30 Minutes$68.47$77.81
90833Individual Psychotherapy with Evaluation and Management Services, 30 minutes$71.00$71.18
90834Individual Psychotherapy, 45 Minutes$91.18$103.28
90836Individual Psychotherapy with Evaluation and Management Services, 45 minutes$89.74$90.02
90837Individual Psychotherapy, 60 Minutes$136.95$152.48
90838Individual Psychotherapy with Evaluation and Management Services, 60 minutes$118.57$119.33
99201Evaluation and Management Services, Outpatient, New Patient$46.49Not Covered
99202Evaluation and Management Services, Outpatient, New Patient$77.48$73.97
99203Evaluation and Management Services, Outpatient, New Patient$109.92$113.75
99204Evaluation and Management Services, Outpatient, New Patient$166.86$169.93
99205Evaluation and Management Services, Outpatient, New Patient$209.75$224.36
99211Evaluation and Management Services, Outpatient, Established Patient$23.07$23.03
99212Evaluation and Management Services, Outpatient, Established Patient$45.77$56.88
99213Evaluation and Management Services, Outpatient, Established Patient$75.32$92.47
99214Evaluation and Management Services, Outpatient, Established Patient$110.28$131.20
99215Evaluation and Management Services, Outpatient, Established Patient$147.76$183.19
99354Prolonged Services$132.26 $132.09
99355Prolong Services with E/M$100.91$100.33
90847Family psychotherapy with patient, 50 minutes$107.19$102.59
90846Family psychotherapy without patient, 50 minutes$103.58$99.10
96105Assessment of aphasia and cognitive performance$101.54
96112Developmental testing administration by a physician or qualified health care professional, 1st hr$131.55
96113Developmental testing administration by a physician or qualified health care professional, each additional hour$58.62
96116Neurobehavioral status exam performed by a physician or qualified health professional, first hour$97.00
96121Neurobehavioral status exam performed by a physician or qualified health professional, additional hour$82.35
96125Standardized cognitive performance test administered by health care professional$107.12
96127Brief emotional and behavioral assessment$4.89
96130Psychological testing and evaluation by a physician or qualified health care professional, first hour$120.73
96131Psychological testing and evaluation by a physician or qualified health care professional, each additional hour$91.42
96132Neuropsychological testing and evaluation by a physician or qualified health care professional, first hour$133.29
96133Neuropsychological testing and evaluation by a physician or qualified health care professional, each additional hour$103.98
96136Neuropsychological or psychological test administration and scoring by a physician or qualified health care professional, first hour$46.76
96137Neuropsychological or psychological test administration and scoring by a physician or qualified health care professional, each additional hour$41.87
96138Neuropsychological or psychological test administration and scoring by a technician, first hour$37.34
96139Neuropsychological or psychological test administration and scoring by a technician, each additional hour$37.34

(Source)

Psychological and Neuropsychological Services Coding Guidelines

Each psych testing CPT code is different.  Maker sure to review current Medicare service provider guidelines to ensure you’re exceeding expectations on behalf of yourself and your clients.

Ensure direct clinical observation (CPT Code 96116).

Review their records (CPT Code 96118).

Make sure to complete forms and questionnaires associated with their files (not billable with Medicare in 2021).

Select, administer, and interpret neuropsych testing directly by a neuropsychologist (CPT Code 96118) or a technician under supervision (96119), or perhaps even by a computerized test (CPT Code 96120).

Integrate the test findings across all aforementioned data points by the neuropsychologist (CPT Code 96118).

Formulate differential diagnosis, including diagnostic conclusions and treatment recommendations (again 96118).

Provide feedback directly related to the testing procedures, results, implications, and conclusions including treatment recommendations and follow up as needed.

Create a written report for the patient and referring healthcare professional.

Source:  Medicare Coding Guidelines

See the above link for more information about exclusions including testing for Alzheimers disease.

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