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Standardized cognitive performance testing, as represented by CPT® Code 96125, involves a structured assessment of cognitive abilities conducted by a qualified health care professional, such as a speech-language pathologist or occupational therapist. This testing is designed to evaluate various cognitive functions, including memory, attention, and problem-solving skills, using standardized tools like the Ross Information Processing Assessment. The procedure is time-based, meaning that the billing is calculated based on the total hours spent by the professional in direct interaction with the patient. This includes not only the time spent administering the tests but also the time dedicated to interpreting the results and preparing a comprehensive report. The qualified health care professional is responsible for selecting the appropriate cognitive tests tailored to the patient's needs, ensuring that the assessment is relevant and effective. After the testing is completed, the professional analyzes the raw and standardized scores obtained from the assessments, which are crucial for understanding the patient's cognitive performance. Finally, a detailed written report is generated and forwarded to the requesting physician, providing essential insights into the patient's cognitive status and any recommendations for further intervention or support.
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The standardized cognitive performance testing represented by CPT® Code 96125 is indicated for various conditions where cognitive assessment is necessary. These indications may include:
The procedure for standardized cognitive performance testing involves several key steps, each critical to ensuring accurate assessment and reporting. The steps include:
Post-procedure care following standardized cognitive performance testing typically involves the communication of results to the patient and the referring physician. The qualified health care professional may discuss the findings of the cognitive assessment with the patient, providing insights into their cognitive strengths and weaknesses. Additionally, the report generated will include recommendations for any necessary follow-up evaluations, interventions, or referrals to other specialists if indicated. The professional may also suggest strategies for cognitive rehabilitation or support based on the assessment results. Overall, the post-procedure phase is essential for ensuring that the patient understands their cognitive status and the next steps in their care plan.
| Short Descr | COGNITIVE TEST BY HC PRO | Medium Descr | STANDARDIZED COGNITIVE PERFORMANCE TESTING | Long Descr | Standardized cognitive performance testing (eg, Ross Information Processing Assessment) per hour of a qualified health care professional's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 7 - Physical Therapy Service, for which Payment may not be Made | Multiple Procedures (51) | 5 - Special payment adjustment rules on the RVU practice expense component of multiple therapy service applies... | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Service Paid under Fee Schedule or Payment System other than OPPS | Berenson-Eggers TOS (BETOS) | T2D - Other tests - other | MUE | 2 | CCS Clinical Classification | 218 - Psychological and psychiatric evaluation and therapy |
| GN | Services delivered under an outpatient speech language pathology plan of care | KX | Requirements specified in the medical policy have been met | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GP | Services delivered under an outpatient physical therapy plan of care | GO | Services delivered under an outpatient occupational therapy plan of care | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | GZ | Item or service expected to be denied as not reasonable and necessary | 97 | Rehabilitative services: when a service or procedure that may be either habilitative or rehabilitative in nature is provided for rehabilitative purposes, the physician or other qualified health care professional may add modifier 97 to the service or procedure code to indicate that the service or procedure provided was a rehabilitative service. rehabilitative services help an individual keep, get back, or improve skills and functioning for daily living that have been lost or impaired because the individual was sick, hurt, or disabled. | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 96 | Habilitative services: when a service or procedure that may be either habilitative or rehabilitative in nature is provided for habilitative purposes, the physician or other qualified health care professional may add modifier 96 to the service or procedure code to indicate that the service or procedure provided was a habilitative service. habilitative services help an individual learn skills and functioning for daily living that the individual has not yet developed, and then keep and/or improve those learned skills. habilitative services also help an individual keep, learn, or improve skills and functioning for daily living. | AH | Clinical psychologist | AJ | Clinical social worker | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | GT | Via interactive audio and video telecommunication systems | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | U5 | Medicaid level of care 5, as defined by each state | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2008-01-01 | Added | First appearance in code book in 2008. |
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