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Neuropsychological Services

Revised: 08-19-2016

Neuropsychological services:

  • • Include assessment and testing
  • • Identify the internal and external restrictions of a recipient’s cognitive, emotional, behavioral and social impairments
  • • Are skills-based interventions provided to recipients with neurological disorders that result in cerebral dysfunction
  • Eligible Neuropsychological Providers

    To enroll with Minnesota Health Care Programs (MHCP) to be an eligible provider of clinical neuropsychological services, you must meet one of the following four criteria:

  • • Have a diploma from one of the following:
  • • American Board of Clinical Neuropsychology (ABCN)
  • • American Board of Professional Neuropsychology (ABPN)
  • • American Board of Pediatric Neuropsychology (ABPdN)
  • • Be credentialed by another state’s board of psychology examiners in the specialty of clinical neuropsychology. The other state’s board must use equivalent requirements to those specified by one of the above-named boards
  • • Have earned a doctoral degree in psychology from an accredited university training program and meet all three of the following criteria:
  • • Have completed an internship, or similar experience, in a clinically relevant area of professional psychology
  • • Have the equivalent of two (full-time) years of experience and specialized training in clinical neuropsychology and related neurosciences with:
  • • At least one year at the post-doctoral level
  • • Supervision by a clinical neuropsychologist
  • • Hold a current license to practice psychology independently, in accordance with Minnesota Statutes, sections 148.88–148.98
  • • Have been enrolled with MHCP as an eligible provider of neuropsychological assessment before December 31, 2010
  • To enroll with MHCP, you must submit proof that you meet one of the above four criteria.

    In this section, “qualified neuropsychologist” means a neuropsychologist who meets one of the above four criteria and is enrolled as an eligible provider with MHCP.

    Covered Neuropsychological Services

    Neuropsychological Assessment

    Neuropsychological assessment is a specialized clinical assessment of the recipient’s underlying cognitive abilities related to thinking, reasoning and judgment. The assessment must be conducted by a qualified neuropsychologist.

    The following components are included in the service. Do not bill for them separately:

  • • Face-to-face interview
  • • Interpretation of test results
  • • Preparation and completion of a written report
  • • Face-to-face feedback provided to recipient as part of the assessment process
  • A recipient is eligible for a neuropsychological assessment if at least one of the following criteria is met:

  • • A brain disorder is known or strongly suspected to exist because of the patient’s medical history or a neurological evaluation. Examples of brain disorders include the following:
  • • Brain disorder resulting from past significant head trauma
  • • Brain tumor
  • • Stroke
  • • Seizure disorder
  • • Multiple sclerosis
  • • Neurodegenerative disorder
  • • Brain disorder resulting from significant exposure to neurotoxins
  • • Brain disorder resulting from central nervous system infection
  • • Metabolic or toxic encephalopathy
  • • Fetal alcohol syndrome
  • • Congenital malformations of the brain
  • • Cognitive or behavioral symptoms suggest the recipient has an organic condition that cannot be readily attributed to functional psychopathology. Examples include the following:
  • • Poor memory or impaired problem solving
  • • Change in mental status evidenced by lethargy, confusion or disorientation
  • • Deterioration in level of functioning
  • • Marked behavioral or personality change
  • • In children or adolescents, significant delays in acquiring academic skill or poor attention relative to peers
  • • In children or adolescents, significant plateau in expected development of cognitive, social, emotional or physical function relative to peers
  • • In children or adolescents, significant inability to develop expected knowledge, skills or abilities as required to adapt to new or changing cognitive, social, emotional or physical demands
  • Neuropsychological Testing

    Neuropsychological testing means administering standardized tests and measures designed to evaluate the recipient’s ability to:

  • • Attend to, process, interpret, comprehend, communicate, learn and recall information
  • • Use problem solving and judgment
  • Neuropsychological testing must be:

  • • Administered or clinically supervised by a qualified neuropsychologist
  • • Validated in a face-to-face interview between the recipient and a qualified neuropsychologist
  • A recipient is eligible for neuropsychological testing when the recipient has one of the following:

  • • A significant mental status change that is not a result of a metabolic disorder and has failed to respond to treatment
  • • In children or adolescents, a significant plateau in expected development of cognitive, social, emotional or physical function relative to peers
  • • In children or adolescents, a significant inability to develop expected knowledge, skills or abilities as required to adapt to new or changing cognitive, social, emotional or physical demands
  • • A significant behavioral change, memory loss or other organic brain injury
  • • Suspected neuropsychological impairment in addition to functional psychopathology
  • • Traumatic brain injury
  • • Stroke
  • • Brain tumor
  • • Substance abuse or dependence
  • • Cerebral anoxic or hypoxic episode
  • • Central nervous system infection or other infectious disease
  • • Neoplasms or vascular injury of the central nervous system
  • • Neurodegenerative disorder
  • • Demyelinating disease
  • • Extrapyramidal disease
  • • Exposure to systemic or intrathecal agents or cranial radiation known to be associated with cerebral dysfunction
  • • Systemic medical condition known to be associated with cerebral dysfunction, including renal disease, hepatic encephalopathies, cardiac anomalies, sickle cell disease and related hematologic anomalies, and autoimmune disorders such as lupus erythematosus or celiac disease
  • • Congenital, genetic, or metabolic disorder known to be associated with cerebral dysfunction, such as phenylketonuria, craniofacial syndromes or congenital hydrocephalus
  • • Severe or prolonged malnutrition or malabsorption syndrome
  • • Condition presenting in a manner making it difficult for a clinician to distinguish between the following:
  • • the neurocognitive effects of a neurogenic syndrome (such as dementia or encephalopathy) and
  • • a major depressive disorder when adequate treatment has not resulted in improvement in neurocognitive functioning, or another disorder (for example, autism, selective mutism, anxiety disorder, or reactive attachment disorder)
  • Neuropsychological testing is not covered when performed:

  • • Primarily for educational purposes
  • • Primarily for vocational counseling or training
  • • For personnel or employment testing
  • • As a routine battery of psychological tests given at inpatient admission or continued stay
  • • For legal or forensic purposes
  • Neuropsychological Rehabilitation

    Neuropsychological rehabilitation is a program to help a recipient do one of the following:

  • • Restore neuropsychological abilities
  • • Acquire and use compensatory methods to improve post-injury adjustment and adaptive living skills
  • Cognitive Rehabilitation

    Cognitive rehabilitation services are skills-based interventions provided to a recipient with a current diagnosis of neurological disorder resulting in cerebral dysfunction. Cognitive rehabilitation identifies the internal and external restrictions of the recipient’s cognitive, emotional, behavioral and social impairments. Use this information to design and implement a rehabilitation program to help the recipient to do one of the following:

  • • Restore neuropsychological abilities
  • • Acquire and use compensatory methods to improve post-injury adjustment and adaptive living skills
  • Interventions must be authorized and provided by a doctoral-prepared clinical neuropsychologist or a multidisciplinary rehabilitation team under the clinical supervision of a doctoral-prepared clinical neuropsychologist.

    For MHCP to cover cognitive rehabilitation, the rehabilitation must be:

  • • Supported by a recent diagnostic assessment and the results of a neuropsychological assessment conducted within the past 365 days
  • • Conducted on a one-on-one basis (for 1–3 recipients) or in a group (for 4–9 recipients)
  • • Documented in both of the following ways:
  • • Daily, by use of a checklist of available therapies, with the therapies that the recipient participated in checked
  • • Weekly, by summary of the information required in the recipient’s record
  • Authorization Requirements

    You must request authorization for services in excess of:

  • • 15 cumulative hours of neuropsychological assessment (96116) and neuropsychological testing (96118 or 96119) in a calendar year
  • • Five sessions of neuropsychological testing (96120) in a calendar year
  • Billing

    Bill neuropsychological services online using MN–ITS 837P.

  • • Do not bill 96116 on the same day as 96150 or 96151
  • • Comply with National Correct Coding Initiative (NCCI) standards for applying appropriate modifiers when billing any of the following combination of codes on the same day:
  • • 96118 with 96119 or 96120
  • • 96119 with 96116, 96118 or 96120
  • • Other service code pairings with 96118, 96119 or 96120
  • Neuropsychological Services

    Procedure Code

    Modifier

    Brief Description

    Unit

    Service Limitations

    96116

     

    Neuropsychological assessment by a qualified neuropsychologist

    1 hour

  • • Authorization is required for more than 15 cumulative hours of 96116, 96118 and 96119 in a calendar year

  • • The date of service for 96116 must be the date all components of the assessment are complete, including interpretation of test results and preparing the report

  • • Authorization is required for more than five sessions of 96120 in a calendar year
  • 96118

     

    Neuropsychological testing
    administered by a qualified neuropsychologist, interpretation, analysis, report

    1 hour

    96119

     

    Neuropsychological testing
    administered by a clinically supervised technician, interpretation and report by a qualified neuropsychologist

    1 hour

    96120

     

    Neuropsychological testing
    administered by computer, interpretation and report by a qualified neuropsychologist

    1 session

    H2012

    HK

    Cognitive rehabilitation

    Behavioral Health Day Treatment

    1 hour

  • • Authorization is required before you provide service
  • • Services may be reauthorized every 90 days with demonstration of medical necessity and progress
  • • An eligible recipient may receive up to four hours per day and 390 hours per calendar year
  • • Services must be provided by a specialized cognitive rehabilitation program located in an outpatient hospital, a comprehensive outpatient rehabilitation facility or a rehabilitation agency
  • You must be an MHCP-enrolled provider to provide and bill for neuropsychological services.

    Legal References

    Minnesota Rules, part 9505.0370, subparts 22 and 23 (Definitions)
    Minnesota Rules, part 9505.0372, subparts 2 and 3
    (Covered Services)

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    Updated: 8/19/16 9:23 AM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 8/19/16 9:23 AM