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The CPT® Code 96131 refers to psychological testing evaluation services conducted by a physician or other qualified healthcare professional. This code encompasses a comprehensive process that includes the integration of patient data, interpretation of standardized test results, and clinical data. It also involves clinical decision-making, treatment planning, and the generation of a report. Additionally, this code covers the provision of interactive feedback to the patient, family members, or caregivers when performed. The services are billed for each additional hour spent on these activities, and it is important to note that this code is used in conjunction with the primary procedure code, which is CPT® Code 96130, designated for the first hour of service. Psychological testing evaluation may involve a psychodiagnostic assessment that evaluates emotional, interpersonal, and intellectual functioning, as well as thought processes, personality traits, and any existing psychopathology. Standardized tests such as the Minnesota Multiphasic Personality Inventory (MMPI), Rorschach Inkblot Test, and Wechsler Adult Intelligence Scale (WAIS) may be utilized during this evaluation. The time-based nature of this code reflects the physician's or qualified healthcare professional's time spent interpreting test results, analyzing raw and standardized scores, preparing reports, and planning treatment, all while incorporating clinical decision-making. Furthermore, the evaluation services may include providing interactive feedback to the patient and their support system, ensuring a comprehensive understanding of the assessment outcomes.
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The psychological testing evaluation services represented by CPT® Code 96131 are indicated for a variety of conditions and circumstances that necessitate a thorough assessment of an individual's psychological state. These indications may include, but are not limited to, the following:
The procedure for psychological testing evaluation services under CPT® Code 96131 involves several key steps that ensure a comprehensive assessment of the patient's psychological state. Each step is critical to the overall evaluation process.
Post-procedure care following the psychological testing evaluation services under CPT® Code 96131 may involve several considerations. After the evaluation, it is important for the healthcare professional to schedule follow-up appointments to discuss the results in detail and to monitor the patient's progress. The interactive feedback provided during the evaluation should be reinforced, allowing the patient and their support system to ask questions and clarify any uncertainties regarding the findings and treatment recommendations. Additionally, ongoing support and resources may be offered to assist the patient in implementing the treatment plan. It is also essential to document any changes in the patient's condition or response to treatment in subsequent visits, ensuring continuity of care and effective management of the patient's psychological health.
| Short Descr | PSYCL TST EVAL PHYS/QHP EA | Medium Descr | PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR | Long Descr | Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; each additional hour (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 04 - Physician supervision policy does not apply when procedure is furnished by a qualified, independent psychologist... | 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 | Items and Services Packaged into APC Rates | Berenson-Eggers TOS (BETOS) | none | MUE | 7 |
| 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. | 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. | AH | Clinical psychologist | GW | Service not related to the hospice patient's terminal condition | UC | Medicaid level of care 12, as defined by each state | FQ | The service was furnished using audio-only communication technology | GT | Via interactive audio and video telecommunication systems | CR | Catastrophe/disaster related | 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 | GA | Waiver of liability statement issued as required by payer policy, individual case | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 93 | Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only 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 away 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 is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. | 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. | AJ | Clinical social worker | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GC | This service has been performed in part by a resident under the direction of a teaching physician | GQ | Via asynchronous telecommunications system | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GZ | Item or service expected to be denied as not reasonable and necessary | H9 | Court-ordered | HE | Mental health program | HN | Bachelors degree level | HO | Masters degree level | HP | Doctoral level | KX | Requirements specified in the medical policy have been met | QJ | Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b) | U4 | Medicaid level of care 4, as defined by each state | U8 | Medicaid level of care 8, as defined by each state | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | 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 | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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