Neuropsychological Services

Revised: October 17, 2022

· Overview

· Eligible Providers

· Eligible Members

· Covered Services

· Noncovered Services

· Authorization Requirements

· Billing

· Legal References

Overview

Neuropsychological services:

· Include assessment and testing

· Identify the internal and external restrictions of a person’s cognitive, emotional, behavioral and social impairments

· Are skills-based interventions provided to people with neurological disorders that result in cerebral dysfunction

Eligible Providers

Licensed psychologists with a post-doctoral neuropsychology specialty who have been approved by DHS to provide neuropsychological services.

Eligible Members

Members eligible for MHCP may receive neuropsychological services if they meet the criteria under the specific types of covered services.

Covered Services

Neuropsychological Assessment

Neuropsychological assessment is a specialized clinical assessment of the MHCP member’s underlying cognitive abilities related to thinking, reasoning and judgment. A qualified neuropsychologist must conduct the assessment.

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 member as part of the assessment process

A member is eligible for a neuropsychological assessment if they meet at least one of the following criteria:

· 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 member 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 member’s ability to:

· Attend to, process, interpret, comprehend, communicate, learn and recall information

· Use problem solving skills and judgment

Neuropsychological testing must be:

· Administered or clinically supervised by a qualified neuropsychologist

· Validated in a face-to-face interview between the member and a qualified neuropsychologist

MHCP covers neuropsychological testing when the member 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 Rehabilitation

Neuropsychological rehabilitation is a program to help a member 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 member with a current diagnosis of neurological disorder resulting in cerebral dysfunction. Cognitive rehabilitation identifies the internal and external restrictions of the member’s cognitive, emotional, behavioral and social impairments. Use this information to design and implement a rehabilitation program to help the member to do one of the following:

· Restore neuropsychological abilities

· Acquire and use compensatory methods to improve post-injury adjustment and adaptive living skills

A doctoral-prepared clinical neuropsychologist or a multidisciplinary rehabilitation team under the clinical supervision of a doctoral-prepared clinical neuropsychologist must authorize and provide interventions.

MHCP covers cognitive rehabilitation if it is:

· 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 members) or in a group (for 4–9 members)

· Documented in both of the following ways:

· Daily, by use of a checklist of available therapies, with the therapies that the member participated in checked

· Weekly, by summary of the information required in the member’s record

Noncovered Services

MHCP does not cover neuropsychological testing 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

Authorization Requirements

You must request authorization for services in excess of:

· 15 cumulative hours of neurobehavioral status exam, neuropsychological testing evaluation and neuropsychological test administration in a calendar year

· Five sessions of neuropsychological test administration 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:

· 96132 with 96136, 96138 or 96146

· 96138 with 96116, 96132 or 96146

· Other service code pairings with 96132, 96138 or 96146

Neuropsychological Services

Procedure Code	Modifier	Brief Description	Unit	Service Limitations
96116		Neurobehavioral status exam by a physician or qualified neuropsychologist, includes face–to-face time with patient and interpreting test results	1 hour	· Authorization is required for more than 15 cumulative hours of 96116, 96121, 96132, 96133, 96136, 96137, 96138, 96139 and in a calendar year · The date of service for 96116, 96121, 96132, 96133, 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 96146 in a calendar year
96121		Each additional hour used in conjunction with 96116	1 hour
96132		Neuropsychological testing evaluation administered by a physician or qualified neuropsychologist, interpretation, analysis, report	1 hour
96133		Each additional hour used in conjunction with 96132	1 hour
96136		Neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests	30 minutes
96137		Each additional 30 minutes used in conjunction with 96136	30 minutes
96138		Neuropsychological test administration and scoring by a clinically supervised technician, interpretation and report by a qualified neuropsychologist	30 minutes
96139		Each additional 30 minutes used in conjunction with 96138	30 minutes
96146		Neuropsychological test administration, with single automated, standardized instrument via electronic platform with automated results only.	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 member 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

Legal References

Minnesota Statutes 256B.0671, subdivision 8
Minnesota Statutes 256B.0671, subdivision 9