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Official Description

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

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

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.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The standardized cognitive performance testing represented by CPT® Code 96125 is indicated for various conditions where cognitive assessment is necessary. These indications may include:

  • Assessment of Cognitive Impairment This testing is often performed to evaluate patients who may be experiencing cognitive decline or impairment due to various factors, including age-related changes, neurological disorders, or traumatic brain injuries.
  • Pre- and Post-Treatment Evaluation It is utilized to assess cognitive function before and after treatment interventions, allowing for the measurement of changes in cognitive abilities over time.
  • Diagnostic Clarification The testing can aid in the differential diagnosis of cognitive disorders, helping to clarify the nature and extent of cognitive deficits in patients.
  • Rehabilitation Planning Results from the testing can inform rehabilitation strategies and interventions tailored to the patient's specific cognitive needs.

2. Procedure

The procedure for standardized cognitive performance testing involves several key steps, each critical to ensuring accurate assessment and reporting. The steps include:

  • Step 1: Patient Preparation The qualified health care professional prepares the patient for the testing process, explaining the purpose and nature of the assessments to ensure the patient is comfortable and understands what to expect.
  • Step 2: Test Selection The professional selects the appropriate standardized cognitive tests based on the patient's specific needs and presenting concerns, ensuring that the chosen assessments are relevant and suitable for the evaluation.
  • Step 3: Administration of Tests The professional administers the selected cognitive tests in a face-to-face setting, engaging with the patient throughout the process to facilitate accurate responses and maintain a supportive environment.
  • Step 4: Scoring and Analysis After the tests are completed, the professional derives raw and standardized scores from the test results. This analysis is crucial for interpreting the patient's cognitive performance and identifying areas of strength and weakness.
  • Step 5: Report Preparation Finally, the qualified health care professional prepares a detailed written report summarizing the findings from the cognitive assessments, including interpretations of the scores and any recommendations for further action or intervention. This report is then sent to the requesting physician for review.

3. Post-Procedure

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
Date
Action
Notes
2008-01-01 Added First appearance in code book in 2008.
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